Radiographic Analysis of Pedicle Screw Retractor-Assisted Transforaminal Lumbar Interbody Fusion for Single-Segment Spondylolisthesis in Adults: A Retrospective Study and Technical Note

Objectives The objective of this study was to introduce a retractor that can be temporarily installed on unilateral pedicle screws to achieve distraction-reduction and nerve root protection, and to analyze the efficacy and safety of retractor-assisted transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar spondylolisthesis. Methods This was a retrospective study of 125 patients who underwent retractor-assisted TLIF for single-segment spondylolisthesis from November 2017 to February 2021. Based on morphology, patients were divided into degenerative (N = 66) and isthmic groups (N = 59). Differences in demographics and preoperative characteristics between the groups were analyzed using the independent samples t-test and chi(2) test. Changes in radiographic parameters (disc height, foramen height, spondylolisthesis degree, slippage length, and segmental lordosis) before and after surgery were compared using the paired samples t-test. Logistic regression analysis was performed to analyze the relationship between facet joint angle (FJA) and degenerative lumbar spondylolisthesis (DLS). Results Unilateral screw retractor-assisted TLIF significantly corrected spondylolisthesis and improved disc height and segmental lordosis (p < 0.05). There was no significant difference in foramen height between the two sides before and after operation (pre: 15.81 +/- 3.58 mm vs 15.69 +/- 3.68 mm, p = 0.599; post: 18.65 +/- 2.31 mm vs 18.74 +/- 2.26 mm, p = 0.516). The degree of spondylolisthesis in the DLS group before surgery was significantly lower than that in the isthmic spondylolisthesis group (17.70 +/- 5.62% vs 25.18 +/- 9.73%, p < 0.001), whereas a similar degree of correction could be achieved after surgery (5.91 +/- 3.12% vs 7.16 +/- 5.69%, p = 0.135). FJAs from L3/4 to L5/S1 were significantly smaller in patients with DLS than those in with isthmic spondylolisthesis (p < 0.05). Patients with facet sagittalization were more likely to have DLS (beta: -0.101, odds ratio [OR]:0.904, 95% confidence interval [CI]: 0.874-0.934, p < 0.001), while the cut-off FJA of L4/5 for predicting L4 spondylolisthesis was 53.19. Conclusions Pedicle screw retractor-assisted TLIF is effective and safe in treating both degenerative and isthmic lumbar spondylolisthesis. The unilateral retractor has the capacity to maintain the disc height achieved by paddle distractors, which optimizes the nerve protection and distractor placement. Patients with an FJA on L4/5 <53.19 were more likely to have DLS.