Application efficacy of a method of minimally invasive posterior interbody stabilization of vertebrae using distraction cages in patients with lumbar spondylolisthesis

Abstract

In press

Background. Degenerative Lumbar Spondylolisthesis (DLS) is a prevalent cause of neurogenic symptoms in older adults and is frequently managed surgically when conservative therapy fails. Comparative effectiveness of decompression and fusion strategies in DLS remain debated in contemporary evidence.

Aim. To evaluate the clinical efficacy and biomechanical rationale of the proprietary MIS-PLIF technique using distraction cages in patients with degenerative lumbar spondylolisthesis.

Materials and Methods. Pre-clinical FEA was provided in a detailed three-dimensional lumbosacral model (L3–S1). Clinical study was as a prospective, controlled, single-center interventional enrolling 24 patients with symptomatic DLS (median age 56 years; 18 females and 6 males; median body mass index 32 kg/m²). Patients of the main group were treated with the proprietary MIS-PLIF distraction-cage method, of comparison group – with standard MIS-PLIF using static cages, and a control group managed with alternative interbody fusion strategies. Non-parametric statistical testing was used at p<0.05. The research was conducted as a private initiative of the authors, did not receive funding from grant programs.

Research Ethics. The study was conducted in accordance with the World Medical Association Declaration of Helsinki and approved by the institutional ethics committee (Protocol No.7 of October 10, 2017).

Results. In the clinical stage, the main group (n=5) treated with the proprietary MIS-PLIF technique exhibited significantly lower operative trauma: median blood loss was 100 mL compared to 500 mL in the control group (p<0.05). Operative time was reduced by half, reaching 180 min versus 360 min in open surgical approaches (p<0.05). Early clinical outcomes in the main group included a more pronounced reduction in pain intensity (VAS median decrease of 4 points) and improved functional status (ODI median improvement of 10 points). Radiographic assessment confirmed the method's superiority in restoring intervertebral disc height (median +10 mm) and effective correction of sagittal alignment parameters (SVA, PT, SS), facilitating accelerated patient recovery.

Conclusions. The tested MIS-PLIF technique using an expandable distraction cage appears feasible and clinically advantageous in early outcomes, providing a coherent biomechanical and medical rationale.

Keywords: segmental lordosis restoration, spinal-pelvic balance, distraction cage biomechanics, sagittal alignment correction, postoperative neurological recovery, minimally invasive posterior lumbar interbody fusion clinical outcomes.