Local Autograft Versus Iliac Crest Bone Graft PSF-Augmented TLIF in Low-Grade Isthmic and Degenerative Lumbar Spondylolisthesis

Study Design: Prospective randomized controlled cohort study. Objective: To compare the outcome of local autograft versus iliac crest bone graft (ICBG) stand-alone transforaminal lumbar interbody fusion (TLIF) in lumbar spondylolisthesis. Methods: One hundred eight patients with low-grade single-level spondylolisthesis underwent operation with pedicular screw fixation (PSF)-augmented stand-alone TLIF. Patients were randomly divided into groups according to bone graft: group I, autograft group; and group II, ICBG group, with 54 patients each. Fifty-nine patients had isthmic spondylolisthesis and 49 had degenerative spondylolisthesis. Clinical outcome parameters included Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and patient's satisfaction, while the radiological parameters included fusion rate, slip reduction, segmental angle, and disc height. The mean follow-up period was 38 +/- 19 months, with a minimum 24 of months. Results: The preoperative VAS of back pain improved from 8 +/- 3.1 to 3.4 +/- 2.9 and from 8 +/- 3.2 to3.6 +/- 2.6 in group I and group II, respectively. The preoperative ODI improved from 41.4 +/- 8 to 12.3 +/- 7 and from 39 +/- 9 to 13 +/- 8 in group I and group II, respectively. The fusion rate was 93% in group I and 94.5% in group II. The percentage of slip was reduced from 26.7 +/- 7.1% to 16.5 +/- 6.1% in group I and from 27.4 +/- 8.25 to 15.8 +/- 5.2% in group II. Intervertebral disc height increased from 25.27 +/- 14.62 to 46.38 +/- 15.41 in group I and from 22.29 +/- 13.72 to 45.15 +/- 16.77 in group II. Segmental angle improved from 10.5 +/- 8.1 degrees to 16.7 +/- 5.4 degrees in group I and from 11.6 +/- 5.3 degrees to 15.9 +/- 6.2 degrees in group II. There was no significant difference of the above-mentioned parameters between the 2 groups. Conclusion: Patients with single-level low-grade spondylolisthesis can be effectively treated with PSF-augmented stand-alone TLIF using either local autograft or ICBG with no outcome differences between the 2 groups.