Clinical, functional and radiological spinopelvic balance parameters assessment after transforaminal lumbar interbody fusion in grade 1 spondylolisthesis


  • Ninad Sawant Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Mathew Abraham Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Tobin George Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Easwer H. V. Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  • Ganesh Divakar Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India



Grade 1 spondylolisthesis, Lumbar lordosis, Pelvic incidence, Sacral slope, Transforaminal lumbar interbody fusion


Background: The aim was to study effectiveness of TLIF procedure by assessing clinical and radiological spinal sagittal parameters pre and postoperatively.

Methods: 8 patients who underwent TLIF procedure after diagnosis of spondylolisthesis studied prospectively. After recording general information, symptomatology, functional parameters were evaluated using visual analogue scale (VAS), Oswestry disability index (ODI), short form 12 (SF 12) and radiological sagittal balance parameters were assessed by calculating sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), preoperatively and postoperatively during follow up at 1 and 3 months.

Results: We operated 4 (50%) patients at L4-L5 level of degenerative spondylolisthesis, 1 (12.5%) patient of degenerative spondylolisthesis at L5-S1 level and 3 (12.5%) patients of isthmic spondylolisthesis at L5-S1 level. All patients were grade 1 spondylolisthesis according Meyerding classification. After surgery all sagittal spinal balance parameters were not found to be statistically changed from the baseline, although there was minimum improvement. Regarding the clinical outcome measures, both VAS (<0.0001), ODI (<0.0001), and SF12 (<0.0001) improved after surgery significantly.

Conclusions: In most case of grade 1 spondylolisthesis, there was only a minimal imbalance of the sagittal spinal balance parameters and so in situ fusion can be done. Even if a complete reduction of spondylolisthesis was not achieved during surgery, there was correction of a few of the parameters of spinal balance which were deranged preoperatively. Overall TLIF is very good procedure in terms of improvement in clinical and functional parameters in grade 1 spondylolisthesis.



O'Donnell JB. A biomechanical comparison of an interspinous fixation device and a pedicle screw and rod system for posterior fixation. The University of Toledo. 2010.

Panjabi MM. Clinical spinal instability and low back pain. J Electromyograph Kinesiol. 2003;13:371-9.

Price JP, Dawson JM, Schwender JD, Schellhas KP. Clinical and radiologic comparison of minimally invasive surgery with traditional open transforaminal lumbar interbody fusion: a review of 452 patients from a single center. Clin Spine Surg. 2018;31:E121‐6.

Adogwa O, Parker SL, Bydon A, Cheng J, McGirt MJ. Comparative effectiveness of minimally invasive versus open transforaminal lumbar interbody fusion: 2‐year assessment of narcotic use, return to work, disability, and quality of life. J Spinal Disord Tech. 2011;24:479‐84.

Wang YX, Káplár Z, Deng M, Leung JC. Lumbar degenerative spondylolisthesis epidemiology: a systematic review with a focus on gender‐specific and age‐specific prevalence. J Orthop Translat. 2017;11:39‐52.

Labelle H, Roussouly P, Berthonnaud E, Dimnet J, O’Brien M. The importance of spino‐pelvic balance in L5‐s1 developmental spondylolisthesis: a review of pertinent radiologic measurements. Spine. 2005;30:S27‐34.

Meyerding HW. Spondylolisthesis. Surg Gynecol Obstet. 1932;54:371-7.

Chen X, Xu L, Qiu Y, Chen ZH, Zhou QS, Li S, et al. Higher improvement in patient‐reported outcomes can be achieved after transforaminal lumbar interbody fusion for clinical and radiographic degenerative spondylolisthesis classification type D degenerative lumbar spondylolisthesis. World Neurosurg. 2018;114:e293‐300.

Cheng X, Zhang F, Zhang K, Sun X, Zhao C, Li H, et al. Effect of single‐level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients with lumbar degenerative disease. World Neurosurg. 2018;109:e244‐51.

Matsumura A, Namikawa T, Kato M, Ozaki T, Hori Y, Hidaka N, et al. Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis. J Neurosurg Spine. 2017;26:150‐7.

Ould-Slimane M, Lenoir T, Dauzac C, Rillardon L, Hoffmann E, Guigui P, et al. Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance. Eur Spine J. 2012;21(6):1200-6.

Eghbal K, Pourabbas B, Abdollahpour HR, Mousavi R. Clinical, functional, and radiologic outcome of single-and double-level transforaminal lumbar interbody fusion in patients with low-grade spondylolisthesis. Asian J Neurosurg. 2019;14(1):181.

Aoki Y, Nakajima A, Takahashi H, Sonobe M, Terajima F, Saito M, et al. Influence of pelvic incidence-lumbar lordosis mismatch on surgical outcomes of short-segment transforaminal lumbar interbody fusion. BMC Musculoskel Disord. 2015;16(1):213.

Schwab F, Patel A, Ungar B, Farcy JP, Lafage V. Adult spinal deformity- postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine. 2010;35(25):2224-31.

Yang EZ, Xu JG, Liu XK, Jin GY, Xiao W, Zeng BF, et al. An RCT study comparing the clinical and radiological outcomes with the use of PLIF or TLIF after instrumented reduction in adult isthmic spondylolisthesis. Eur Spine J. 2016;25(5):1587-94.

Hey HW, Hee HT. Open and minimally invasive transforaminal lumbar interbody fusion: comparison of intermediate results and complications. Asian Spine J. 2015;9(2):185.

Hammad A, Wirries A, Ardeshiri A, Nikiforov O, Geiger F. Open versus minimally invasive TLIF: literature review and meta-analysis. J Orthopaed Surg Res. 2019;14(1):229.

Parker SL, Mendenhall SK, Shau DN, Zuckerman SL, Godil SS, Cheng JS, et al. Minimally invasive versus open transforaminal lumbar interbody fusion for degenerative spondylolisthesis: comparative effectiveness and cost-utility analysis. World Neurosurg. 2014;82(1-2):230-8.






Original Research Articles