EFFECTIVENESS IN INDIRECT DECOMPRESSION USING MINIMALLY INVASIVE SURGERY - TRANSFORAMINAL LUMBAR INTERBODY FUSION IN SINGLE-LEVEL LUMBOSACRAL SPONDYLOLISTHESIS.

Background: The lateral indirect decompression shows many advantages over the posterior approach for patients with low-grade spondylolisthesis or mild canal stenosis. While the minimally invasive surgery - transforaminal lumbar interbody fusion (MIS TLIF) was considered a favourable approach for most surgeons, it can also archive nerve release without exposure, especially with the use of intraoperative neuromonitoring which provides safer and fewer complications.

Materials and methods: From 2022 to March 2024, 20 single-level lumbosacral spondylolisthesis was performed MIS TLIF technique, in which, the superior-articular process was removed only to enlarge the Kambin's triangle without exposure to nerve structure. Intraoperative neuromonitoring was followed in every single step during surgery. Patient information was recorded during pre-, intra-operation, and follow-up at 6- and 12-months post-operation; we also collected demographic data, operation time, blood loss, VAS, ODI, modified MacNab criteria, radiographic evaluation including x-ray and MRI pre-, post-operation, and complications.

Results: 20 patients were followed up for more than 12 months. Mean age: 52,1 and mean follow-up 15,2 months. VAS back pain: 7,4 preoperatively and 0.8 at the final. VAS of leg pain was 7,1 preoperatively and 0,9 at the final. ODI was 52,4% preoperatively and 15,6% at the final. The mean operation time is 80,7 mins, blood loss is less than 100 ml. The average ambulation is 1,2 days, and the hospital stay is 4,7 days. MIS TLIF was associated with a very good reduction of spondylolisthesis, an increase in disc height (+6 mm), foraminal height (+3,1 mm), and segmental lordosis (+4,8°). The correction to normal of the listhesis was 85%. Pelvic parameters were not significantly changed. According to the modified MacNab criteria: 75% excellent, 20% good, and 5% fair. There was no complication was recorded.

Conclusions: The indirect decompression using MIS TLIF seems to be a safe, effective, and favourable technique in management for patients with single-level lumbosacral spondylolisthesis.