Comparative Analysis of Spinal Fusion Techniques on Pain Relief and Segmental Stability in Spondylolisthesis Patients
Abstract
Background: Spondylolisthesis is a prevalent cause of chronic axial and radicular low back pain worldwide, yet the comparative merit of available fusion strategies remains unresolved. Objective: This study evaluated posterolateral fusion, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for pain relief, functional recovery, and segmental stability in symptomatic spondylolisthesis. Methods: A prospective observational cohort of 128 adults (18–65 years) with radiologically confirmed spondylolisthesis was recruited at the Department of Orthopaedic Surgery, Rajshahi Medical College, between January 2022 and December 2024. Patients underwent posterolateral fusion, posterior lumbar interbody fusion, or transforaminal lumbar interbody fusion. Visual analogue scale pain scores, Oswestry Disability Index scores, radiographic fusion, and complications were recorded preoperatively and at 1, 6, and 12 months, and analysed using SPSS v26.0. Results: Mean patient age was 41.5 ± 13.4 years (65 women, 50.8%); posterolateral fusion (n = 47, 36.7%), transforaminal lumbar interbody fusion (n = 43, 33.6%), and posterior lumbar interbody fusion (n = 38, 29.7%) were performed. Visual analogue scale scores declined from 7.77 ± 1.42 preoperatively to 1.00 ± 0.82 at 12 months (87.1% reduction, p < 0.001), and Oswestry Disability Index scores fell from 54.08 ± 14.54 to 9.76 ± 6.21 (82.0% reduction, p < 0.001). Outcomes were statistically comparable across techniques (ANOVA, all p > 0.05). Solid fusion and segmental stability were confirmed radiographically in all 128 patients (100%) at 12 months, and the overall complication rate was 3.91% (5/128), predominantly asymptomatic implant-related findings, without significant inter-technique variation (χ² p = 0.267). Conclusion: All three fusion techniques produced durable, statistically comparable pain relief, disability reduction, and segmental stability with a low complication burden, supporting individualised technique selection in resource-constrained surgical settings.