Anterior lumbar interbody fusion with percutaneous pedicle screw fixation for multiple-level isthmic spondylolisthesis.

Objective: Multiple-level lumbar isthmic spondylolisthesis is rarely reported. Here, we report 23 consecutive patients who underwent anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) for multiple-level isthmic spondylolisthesis.

Patients And Methods: From June 2008 through December 2014, multiple-level lumbar isthmic spondylolisthesis was diagnosed in 23 patients (6 men, 17 women) at Wooridul Spine Hospital (Busan, South Korea). Isthmic spondylolisthesis occurred at three spinal levels in 2 patients and at two levels in 21 patients. All patients underwent ALIF with PPF. We used the Oswestry Disability Index (ODI) and visual analog scale scores to evaluate the preoperative and postoperative functional outcome, low back pain, and radicular pain. We also evaluated segmental lordosis and the fusion status using radiographs and data from computed tomography.

Results: Isthmic spondylolisthesis occurred from L3 to S1 and mostly occurred at two consecutive spinal levels (i.e., L4-L5 and L5-S1). Significant improvements in the ODI and visual analog scale were observed in patients at final follow up (p<0.05). The mean segmental lordosis significantly increased after operation (from 22.7° to 32.7°). The mean lumbar lordosis significantly increased after operation (from 45.8 to 53.1). Radiographs of all of the patients showed solid fusion at the last follow-up. There was one case of screw fracture at the S1 level; however, in this case the last follow-up radiograph exhibited solid fusion.

Conclusions: Anterior lumbar interbody fusion with PPF can be an effective treatment choice and yield good clinical outcomes in patients with multiple-level isthmic spondylolisthesis.