Results of Transforaminal Lumbar Interbody Fusion (TLIF) for Unstable Degenerative Lumbar Spondylolisthesis (UDLS) in elderly patients: 5-year experience

Abstract

Background: Degenerative Lumbar Spondylolisthesis (DLS) may present with significant disability due to instability. Interbody fusion (IBF) is advocated to achieve the highest possible functional recovery. Objective: To assess the clinical-radiological outcomes and perioperative complications of conventional open Transforaminal Lumbar Interbody Fusion (TLIF) in elderly (age >65 years) patients with single-segment unstable DLS (UDLS). Methods: Between March 2015 and October 2023, records of 79 patients, 22 men and 57 women, aged 65 to 75 years who underwent single-level TLIF for UDLS were reviewed. The patient’s Body Mass Index (BMI) and co-morbidity status were recorded. The study sample was divided into Group A (Male) and Group B (Female). Perioperative clinical outcome was assessed by Visual Analogue Score (VAS) and Oswestry Disability Index (ODI). Radiological fusion was assessed by Brantigan and Steffee criteria and the overall outcome by Wang-Bohlman criteria. Perioperative complications were recorded and analyzed concerning age, sex, and co-morbidities. Statistical analysis was performed using SPSS. Results: Female patients of 65-70 years presented late and had significantly higher BMI, and medical co-morbidities. In both groups, the Mean VAS score [Group-A, 7.9±1.5 to 1.1±1.8; Group B, 7.8±1.7 to 1.3±1.6] and ODI score, [Group-A, 78.5±6.5 to 11.5±7.2; Group B, 76.5±7.5 to 13.6±9.3] had highly significant improvement at last post-operative follow-up. The Mean Operative time, intraoperative blood loss, and postoperative complications had no significant difference between the groups and were not statistically associated with age, sex, or BMI. In both groups, fusion [Group-A, (n=20, 90.91%); Group-B, (n=54, 94.74%] and the overall outcome was satisfactory [Group-A, n=19(86.37%), Group-B, n= 53(92.98%)]. Conclusion: Transforaminal Lumbar Interbody Fusion (TLIF) for single-segment Unstable Degenerative Lumbar Spondylolisthesis (UDLS) can provide satisfactory and favorable outcomes in carefully selected elderly and results in minimum complication.