الفهرس 
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Abstract
One vertebral body slips in relation to the one next to it; this condition is known as spondylolisthesis. When you have spondylolisthesis, your vertebrae are unstable and shift more than they need to.
Somewhere between 4 and 6 percent of us adults has spondylolisthesis or spondylolysis. Approximately 90% of cases with spondylolisthesis manifest at the L5-S1 level, characterised by an anterior translating of the L5 vertebral body on the S1 vertebral body. Spondylolisthesis occurs in the L3-L4 level (3%), with the L4-5 level (3%), and the L2-3 level (3%).
Degenerative, isthmic, traumatic, dysplastic, and pathologic aetiologies account for the vast majority of cases with spondylolisthesis.
Diagnostic challenges arise from the need for clinical and radiological evidence. The gradual development of symptoms and the prevalence of low back pain in the regular populace contribute to the delay of treatment. Axial back pain, radicular pain, and neurogenic claudication are all clinical presentations that must be distinguished from vascular pain.
Important to our diagnosis is the use of neuroimaging techniques; plain x-rays allow us to evaluate the severity of spondylolisthesis and other osteoarthritis processes, CT scans can show us the presence of rare genetic and degenerative spondylolistheses, and MRIs provide information about the contraction of neural structures caused by the slipping vertebral disc.
Initial treatment for spondylolisthesis-related low back pain must be cautious. Conservative treatments include alterations to the patient’s activity level, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, physiotherapy, and epidural steroid injections. While surgery is necessary if radicular symptoms are so severe that they prevent the patient from working or if the disease is worsening or there is a major neurological impairment, the best surgical option is still up for debate.
Forty spondylolisthesis patients who were hospitalised to Minya University Hospital between March 2020 and September 2021 participated in the research. Were split into two groups at random after the fact.
Twenty people in Group(A) had surgery consisting of transpedicular screw fixation and posterior spine inter body fusion using autograft (PLIF) (PEEK cages insertion). Twenty patients from Group(B) had surgery for transpedicular screw fixation and pedicle fusion with autografting (PLF).
At admission, each patient was subjected to a full battery of diagnostic tests, including a physical, neurological, and radiological evaluation as well as a thorough review of their medical history. In order to assess the clinical result and patient satisfaction six months after surgical intervention, only patients who met the inclusion criteria remained in the research.
Regarding sex of patients included in our research there were 6 men and 14 females in PLIF group and two males and 15 females in PLF group, regarding the age of patients in PLIF groups the mean age was 47.85ys and in PLF group the mean age was 46.7ys.
The approximated blood loss was also significantly different between the two procedures, with the PLIF group losing an average of 372.5 ml and the PLF group losing an average of 287.5 ml during surgery, suggesting that the longer PLIF procedure time was at least in part attributable to the longer time needed for cage insertion.
While our research found that the PLIF group saw a greater reduction in pain at 6 months post-op compared to the PLF group, the two groups did not vary significantly in their reduction of radicular pain in the immediate aftermath of surgery.
While the fusion rate was greater in the PLIF group due to disc replacement with interbody cages, it was still lower than the PLF group at 65% after 6 months of postoperative follow up.
Maintaining the height of the intervertebral disc is a goal of both PLIF and PLF. The mean preoperative DSH for the PLIF and PLF groups was 6.88 mm and 7.39 mm, respectively, and rose to 7.45 mm and 7.51 mm postoperatively, respectively.
Both methods led to lower the degree of slippage, mean before slippage angle was 21.2 degree fell to 18.8 degree surgically in PLIF and it fell from 17.7 preoperatively to 17.1 afterwards however the difference in both trials was not statistically significant
Mean ODI values decreased from 72.5% pre-operatively to 13% at 6 months post-operatively in the PLIF group and from 75.7% pre-operatively to 18.7% at 6 months post-operatively in the PLF group, both according to the Oswestery disability index (ODI).
The KWC functional outcome was used in our investigation. Functional outcomes were evaluated using the Kirkaldy-Willis scale, with 65% of patients reporting an excellent outcome, 20% reporting a good outcome, 10% reporting a fair outcome, and 5% reporting a poor outcome in the PLIF group and 50% reporting an excellent outcome, 20% reporting a good outcome, 25% reporting a fair outcome, and 5% reporting a poor outcome in the PLF group.
One patient in the PLIF group had a wound infection that required recurrent dressing and IV antibiotics based on culture and sensitivity; another patient in the PLIF group experienced a Dural rupture; two patients in the PLF group experienced urine retention that resolved within 48 hours postoperatively; and a third patient in the PLF group experienced cage subsidence two months after surgery.
There was no significant difference in the rate of postoperative complications between the two groups (only 5% of patients in each required further surgery).
Although there is general agreement that surgical therapy is necessary, opinions on the best method vary widely among neurosurgeons. Some choose posterior lumbar fusion (PLIF), while others favour posterolateral fusion (PLF).
There was no significant difference in the initial VAS pain score in the legs and back after surgery, in blood loss, in the incidence of complications, or in the ODI scores obtained after surgery.