Background: Spondylolisthesis is a common spinal disorder characterized by anterior displacement of one vertebra over another, with a prevalence of 3% - 10% in the general population. Given ongoing debate regarding optimal graft choice in instrumented fusion, this study aimed to evaluate the clinical and radiological outcomes of lumbar spondylolisthesis treated with posterior decompression and pedicle screw-rod fixation using local autogenous bone graft. Methods: This retrospective study was conducted in the Department of Orthopaedic Surgery, IBN Sina Medical College Hospital, Dhaka, Bangladesh (April 2021-March 2025), including 45 consecutive patients with Meyerding grade I - III lumbar spondylolisthesis treated with posterior decompression and pedicle screw-rod fixation using local autogenous bone graft. Patients with incomplete follow-up were excluded. Outcomes were assessed at ≥12 months (up to 30 months) using VAS, ODI, radiological parameters, and Bridwell and Modified Lee’s fusion grading, with standardized postoperative rehabilitation. Results: A total of 45 patients (mean age 51.1 ± 13.8 years; 48.9% male) were included. L4 - L5 involvement (55.6%) and Grade II spondylolisthesis (64.4%) were most common. Significant improvements were observed in VAS, ODI, slip percentage, slip angle, disc height, and foraminal height (all p < 0.001). Successful fusion (Bridwell Grade I - II) was achieved in 95.6% of patients, with definitive fusion in 80.0%. Postoperative complications occurred in 4 patients (8.9%), including adjacent segment disease, pseudarthrosis, and deep infection, with no neurological deficit, implant failure, or donor-site morbidity. Conclusion: Local autogenous bone graft with instrumented fusion provides safe, effective, and reliable clinical and radiological outcomes in lumbar spondylolisthesis.
References
[1]
Goyal, D.K.C., Tarazona, D.A., Segar, A., Sutton, R., Motto, M.A., Divi, S.N., et al. (2021) Lumbar Pedicle Morphology and Vertebral Dimensions in Isthmic and Degenerative Spondylolisthesis—A Comparative Study. InternationalJournalofSpineSurgery, 15, 243-250. https://doi.org/10.14444/8009
[2]
Mohile, N.V., Kuczmarski, A.S., Lee, D., Warburton, C., Rakoczy, K. and Butler, A.J. (2022) Spondylolysis and Isthmic Spondylolisthesis: A Guide to Diagnosis and Management. TheJournaloftheAmericanBoardofFamilyMedicine, 35, 1204-1216. https://doi.org/10.3122/jabfm.2022.220130r1
[3]
Rayhan, M.F., Rezwan, M. and Sarker, M.M. (2022) Study on Lumbar Interbody Fusion and Posterior Instrumentation in Spondylolisthesis. MOJOrthopedics&Rheumatology, 14, 158-161. https://doi.org/10.15406/mojor.2022.14.00598
[4]
Sleem, A. and Marzouk, A. (2018) Transforaminal Lumbar Interbody Fusion with Local Bone Graft Alone for Single-Level Isthmic Spondylolisthesis. International Journal of Spine Surgery, 12, 70-75.
[5]
Akkawi, I. and Zmerly, H. (2022) Degenerative Spondylolisthesis: A Narrative Review. Acta Bio Medica: Atenei Parmensis, 92, e2021313.
[6]
Kunze, K.N., Lilly, D.T., Khan, J.M., Louie, P.K., Ferguson, J., Basques, B.A., et al. (2020) High-Grade Spondylolisthesis in Adults: Current Concepts in Evaluation and Management. InternationalJournalofSpineSurgery, 14, 327-340. https://doi.org/10.14444/7044
[7]
Yang, J., Yang, Y., Wang, G., Xu, S., Li, G., Zhang, S., et al. (2023) Is Local Autogenous Morselized Bone Harvested from Decompression through a Posterior-Transforaminal Approach Sufficient for Single-Level Interbody Fusion in the Lower Lumbar Spine? BMCMusculoskeletalDisorders, 24, Article No. 12. https://doi.org/10.1186/s12891-023-06131-4
[8]
Yang, X., Wang, D., He, Y., Yan, L., Hao, D. and He, B. (2020) Quantification Evaluation of Structural Autograft versus Morcellized Fragments Autograft in Patients Who Underwent Single-Level Lumbar Laminectomy. ExperimentalandTherapeuticMedicine, 20, 1803-1807. https://doi.org/10.3892/etm.2020.8831
[9]
Li, N., Scofield, J., Mangham, P., Cooper, J., Sherman, W. and Kaye, A.D. (2022) Spondylolisthesis. OrthopedicReviews, 14, Article No. 36917. https://doi.org/10.52965/001c.36917
[10]
Kalhoro, A., Ahmed, K. and Hashim, A.S. (2024) The Operative Efficacy of Decompression and Fixation Surgery for Degenerative Lumbosacral Spondylolisthesis: A Single Institutional Study. JournalofPostgraduateMedicalInstitute, 38, 192-197. https://doi.org/10.54079/jpmi.38.3.3358
[11]
Liu, Z., Liu, J., Tan, Y., He, L., Long, X., Yang, D., et al. (2014) A Comparative Study between Local Bone Graft with a Cage and with No Cage in Single Posterior Lumbar Interbody Fusion (PLIF): A Multicenter Study. ArchivesofOrthopaedicandTraumaSurgery, 134, 1051-1057. https://doi.org/10.1007/s00402-014-2016-6
[12]
Khan, S.N. and Shahzad, H. (2023) Osteobiologics and Value-Based Care: Challenges and Opportunities. InternationalJournalofSpineSurgery, 17, S44-S52. https://doi.org/10.14444/8560
[13]
D’Souza, M., Macdonald, N.A., Gendreau, J.L., Duddleston, P.J., Feng, A.Y. and Ho, A.L. (2019) Graft Materials and Biologics for Spinal Interbody Fusion. Biomedicines, 7, Article 75. https://doi.org/10.3390/biomedicines7040075
[14]
Abou-Madawi, A.M., Ali, S.H. and Abdelmonem, A.M. (2022) Local Autograft versus Iliac Crest Bone Graft PSF-Augmented TLIF in Low-Grade Isthmic and Degenerative Lumbar Spondylolisthesis. GlobalSpineJournal, 12, 70-78. https://doi.org/10.1177/2192568220946319
[15]
Aimar, E., Di Stefano, L., Longhitano, F., Bona, A., Meloni, M., Alfiero, T., et al. (2026) Does Adding an Interbody Cage in L4-L5 Posterolateral Fusion for Degenerative Spondylolisthesis and Stenosis Improve Clinical Outcome? BrainandSpine, 6, Article 105926. https://doi.org/10.1016/j.bas.2026.105926
[16]
Lee, S.C., Chen, J.F., Wu, C.T. and Lee, S.T. (2009) In Situ Local Autograft for Instrumented Lower Lumbar or Lumbosacral Posterolateral Fusion. JournalofClinicalNeuroscience, 16, 37-43. https://doi.org/10.1016/j.jocn.2008.02.009
[17]
Tattari, B.P., Nimmagadda, V.V. and Tapadar, J.I. (2017) A Prospective Study on Surgical Management of Lumbar Spondylolisthesis with Pedicle Screw Fixation and Posterolateral Fusion. InternationalJournalofResearchinOrthopaedics, 3, Article 1113. https://doi.org/10.18203/issn.2455-4510.intjresorthop20174698
[18]
Subramanian, K., Prabu, G.R., Kalyanasundaram, K. and Hariharan, D. (2023) Degenerative Lumbar Spondylolisthesis Treated with Lumbar Interbody Fusion with Cage and Pedicle Screw Fixation—A Prospective Study. International Journal of Academic Medicine and Pharmacy, 5, 765-769.
[19]
Hagenmaier, H.F., Delawi, D., Verschoor, N., Oner, F.C. and van Susante, J.L. (2013) No Correlation between Slip Reduction in Low-Grade Spondylolisthesis or Change in Neuroforaminal Morphology and Clinical Outcome. BMCMusculoskeletalDisorders, 14, Article No. 245. https://doi.org/10.1186/1471-2474-14-245
[20]
Isogai, N., Yoshida, K., Shiono, Y., Sasao, Y., Funao, H. and Ishii, K. (2022) Respective Correction Rates of Lateral Lumbar Interbody Fusion and Percutaneous Pedicle Screw Fixation for Lumbar Degenerative Spondylolisthesis. Medicina, 58, Article 169. https://doi.org/10.3390/medicina58020169
[21]
Zhao, W., Zhou, C., Zhang, H., Guo, J., Han, J., Lin, A., et al. (2023) Clinical, Radiographic and Fusion Comparison of Oblique Lumbar Interbody Fusion (OLIF) Stand-Alone and OLIF with Posterior Pedicle Screw Fixation in Patients with Degenerative Spondylolisthesis. BMCMusculoskeletalDisorders, 24, Article No. 852. https://doi.org/10.1186/s12891-023-06985-8
[22]
Rao, G.P., Azeez, D.M.Q.A. and Kumar, S.A. (2018) Evaluation of the Clinico-Radiological Outcome of Lumbar Interbody Fusion Using Cage and Local Bone Graft in Management of Lumbar Spondylolisthesis. International Journal of Orthopaedics Sciences, 4, 814-822. https://doi.org/10.22271/ortho.2018.v4.i4k.103
[23]
Bydon, A., Dasenbrock, H.H. and Suk, I. (2012) Posterior Lumbar Fusion by Open Technique. In: Qui？ones-Hinojosa, A., Ed., SchmidekandSweetOperativeNeurosurgicalTechniques, Elsevier, 1899-1930. https://doi.org/10.1016/b978-1-4160-6839-6.10166-2
[24]
Tavares, W.M., de Fran？a, S.A., Paiva, W.S. and Teixeira, M.J. (2022) A Systematic Review and Meta-Analysis of Fusion Rate Enhancements and Bone Graft Options for Spine Surgery. ScientificReports, 12, Article No. 7546. https://doi.org/10.1038/s41598-022-11551-8
[25]
Booth, K.C., Bridwell, K.H., Eisenberg, B.A., Baldus, C.R. and Lenke, L.G. (1999) Minimum 5-Year Results of Degenerative Spondylolisthesis Treated with Decompression and Instrumented Posterior Fusion. Spine, 24, Article 1721. https://doi.org/10.1097/00007632-199908150-00014
