From the Research
For a 74-year-old female with L4-L5 spondylolisthesis undergoing spinal surgery, the most effective treatment option is oblique lumbar interbody fusion (OLIF), as it has been shown to have less operative blood loss, a shorter hospital stay, and a higher fusion rate compared to other minimally invasive techniques such as transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) 1.
Surgical Options
The primary surgical options for this patient include decompression with or without fusion. Decompression alone (laminectomy) may be appropriate for mild slippage with predominant leg symptoms, while fusion procedures are typically recommended for moderate to severe slippage or instability.
- Decompression involves removing pressure from the nerves
- Fusion procedures involve stabilizing the spine with screws, rods, and bone graft material
Postoperative Care
Postoperatively, the patient can expect a hospital stay of 2-4 days followed by a recovery period of 3-6 months.
- Pain management initially includes IV narcotics (morphine 2-4mg or hydromorphone 0.5-1mg every 4 hours) transitioning to oral medications like oxycodone 5-10mg every 4-6 hours or hydrocodone/acetaminophen 5/325mg every 6 hours for 2-3 weeks, then tapering to NSAIDs like ibuprofen 600mg three times daily
- Physical therapy typically begins 4-6 weeks after surgery, focusing first on gentle walking and progressing to strengthening exercises
Outcomes and Complications
Outcomes are generally favorable, with 70-80% of patients this age experiencing significant pain relief and improved function, though complete resolution of all symptoms is not always achieved 2.
- Recovery may be slower in older patients
- Complications such as adjacent segment disease (10-15% risk over 5 years), hardware failure (5-10%), or infection (2-4%) are possible
- The patient should be monitored for osteoporosis, which could affect surgical outcomes, and may benefit from calcium (1200mg daily) and vitamin D (800-1000 IU daily) supplementation
Comparison of Surgical Techniques
A systematic review and meta-analysis comparing TLIF and PLIF found that TLIF has advantages over PLIF in terms of complication rate, blood loss, and operation duration, with similar clinical outcomes 3.
- However, the most recent study comparing OLIF, MIS-TLIF, and Endo-TLIF found that OLIF had more benefits, including less operative blood loss, a shorter hospital stay, and a higher fusion rate 1.