Objective: High-grade isthmic spondylolisthesis remains surgically controversial, and evidence on minimally invasive, single-level reduction and fusion with mid-term follow-up remains limited. This study aimed to investigate the efficacy and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous pedicle screw fixation for high-grade (Meyerding Grade III) spondylolisthesis.
Methods: This prospective observational case series included 14 consecutive patients with Meyerding Grade III isthmic spondylolisthesis treated at a single institution between 2014 and 2019. All patients underwent monosegmental MIS-TLIF with percutaneous pedicle screw fixation. Outcome measures included VAS (back and leg pain), ODI, slip percentage, Dubousset lumbosacral angle, and other spinopelvic parameters. Pre- and postoperative comparisons were performed using paired t-tests (p < 0.05).
Results: Fourteen patients had a mean age of 54.9 years with a diagnosis of isthmic spondylolisthesis, Meyerding Grade III. The average estimated blood loss was 273.93 mL (range, 197–380 mL). The average operating time was 142.14 min (range, 125–165 min). The average follow-up duration was 43.5 months, with a range of 38–60 months. In most cases, radicular pain was significantly relieved postoperatively. The mean ODI scores decreased from preoperative 65.56% to postoperative 7.93%. All cases achieved near-anatomic reduction, and lumbosacral lordosis was significantly corrected. The average slip percentage improved from 64.36% (preop) to 5.88% (postop), and the average Dubousset-LSA increased from 81.96° (preop) to 105.93° (postop). The overall sagittal profile improved dramatically.
Conclusions: MIS-TLIF and percutaneous pedicle screw fixation may offer a safe and effective treatment option for high-grade spondylolisthesis, with satisfactory clinical and radiological outcomes.
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