Document Type
Article
Publication Date
1-5-2026
Abstract
INTRODUCTION: As the population ages, L4-L5 degenerative spondylolisthesis is increasingly common. Posterolateral fusion was long standard; interbody cages are widely used for perceived higher fusion rates.
RESEARCH QUESTION: Does adding an interbody cage to posterolateral fusion improve outcomes or reduce complications in elderly patients with grade I spondylolisthesis and severe stenosis?
MATERIALS AND METHODS: We retrospectively studied 319 adults aged 60-85 who underwent single-level L4-L5 fusion (2011-2018) after failed conservative care. Patients received posterior lumbar fusion (PLIF, n = 155) or posterolateral lumbar fusion (PLF, n = 164). Primary outcomes were Oswestry Disability Index (ODI) change and complications over a median five-year follow-up; secondary outcomes were operative time, hospital stay, and transfusions. Multivariable analyses adjusted for age, sex, BMI, year of surgery, and sagittal alignment.
RESULTS: Functional improvement was similar (median ODI reduction ≈22 points; p = 0.97), and implant-related revision and revision-free survival did not differ. Cage use increased overall complications (24.5 % vs 7.9 %), prolonged surgery (125 vs 95 min) and hospital stay (4 vs 3 days), and raised transfusions (9.7 % vs 1.8 %), dural tears (11.6 % vs 2.4 %), and radicular deficits (6.5 % vs 1.2 %). The association between cage use and complications persisted after adjustment.
CONCLUSION: In this elderly, low-grade L4-L5 degenerative spondylolisthesis cohort, adding a posterior interbody cage to instrumented posterolateral fusion did not improve 5-year disability but was associated with higher peri-operative morbidity and greater resource use.
Recommended Citation
Aimar, Enrico; Di Stefano, Lucrezia; Longhitano, Federico; Bona, Alberto; Meloni, Marco; Alfiero, Tommaso; Valente, Federica; Bonomo, Roberta; Bonomo, Giulio; Tancioni, Flavio; and Iess, Guglielmo, "Does Adding an Interbody Cage in L4–L5 Posterolateral Fusion for Degenerative Spondylolisthesis and Stenosis Improve Clinical Outcome?" (2026). Department of Neurosurgery Faculty Papers. Paper 288.
https://jdc.jefferson.edu/neurosurgeryfp/288
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
PubMed ID
41630832
Language
English
Included in
Health Services Research Commons, Neurosurgery Commons, Surgical Procedures, Operative Commons
Comments
This article is the author’s final published version in Brain and Spine, Volume 6, 2026, Article number 105926.
The published version is available at https://doi.org/10.1016/j.bas.2026.105926. Copyright © 2026 The Authors.