Clinical Evaluation Of Transforaminal Lumbar Interbody Fusion In The Treatment Of Double-level Lumbar Spondylolisthesis

Objective: To retrospectively analyze the effect of double-level transforaminal lumbar interbody fusion(TLIF)in the treatment of double-level lumbar spondylolisthesis with sagittal imbalcance.Methods: A retrospective analysis of 36 patients with doublelevel lumbar spondylolisthesis who were diagnosed and treated from January 2015 to May2021.There were 21 patients with L3 and L4 double-level spondylolisthesis,6 males and15 females,aged 44～78 years old,mean 64.7±9.4 years;15 patients with L4 and L5double-level spondylolisthesis,4 males and 11 females,aged 53～79 years old,mean66.5±8.0 years.The sagittal parameters were measured and analyzed at preoperation,postoperation,and the last follow-up by standing full spine X-rays,including: Sagittal vertical axis(SVA),T1 pelvic angle(TPA),T1 spinopelvic inclination(T1-SPi),thoracic lumbar angle(TLA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacrum slope(SS),pelvic incidence minus lumbar lordosis(PI-LL),slip distance(SD),slip angle(SA).The function scores of patients were recorded and analyzed at preoperation,postoperation,and the last follow-up,including Oswestry disability index(ODI),Japanese Orthopaedic Association(JOA)scores,and visual analogue scale(VAS).The imaging and clinical indicators of preoperative,postoperative and the last follow-up were analyzed statistically.Results: All the 36 patients underwent surgical intervention with a mean operation time of 190.28±6.12mins(120～275mins),mean intraoperative blood loss of 345±11ml(210～550ml).All patients had spinal sagittal imbalance before operation,SVA 40.30-150.90 mm,mean 77.58±24.81 mm.The surgical complications occurred in 2 patients with lower extremity numbness relieved with mecobalamin 7 days after surgery.The SVA,TPA,T1-SPi,LL,PT,SS,PI-LL,SD,SA were significantly improved after surgery and at last follow-up(P <0.05),indicating the sagittal balance of lumbar spine was significantly improved after surgery.The postoperative functional scores of patients with double-level lumbar spondylolisthesis(ODI,JOA scores,and VAS)were significantly improved after surgery and at the last follow-up(P <0.05).Conclusion:Double-level TLIF is a safe and effective treatment strategy,which can help patients with double-level spondylolisthesis relieve the symptoms and improve the quality of life,with the stabilization of spine,and reconstruction of sagittal balance.