Lumbosacral spondylolisthesis, characterized by the forward slippage of a vertebra over the one beneath it, is a prevalent spinal condition with potentially severe consequences for patients' quality of life [1]. This condition most commonly affects the L5-S1 vertebrae, leading to significant lower back pain, neural compression, and, in severe cases, debilitating physical impairment. Studies have shown that without proper intervention, patients with high-grade spondylolisthesis may suffer from progressive neurological deficits, including lower extremity weakness and gait disturbances. In countries like Bangladesh, where spinal disorders often go untreated or are misdiagnosed, addressing lumbosacral spondylolisthesis with effective surgical interventions is increasingly important for improving patient outcomes and reducing disability rates.One of the primary interventions for treating symptomatic spondylolisthesis is posterior spinal fusion, which aims to stabilize the affected vertebral segment, thereby alleviating pain and preventing further slippage [2]. The surgical approach typically involves posterior instrumentation—using screws and rods for stabilization—combined with bone grafting to promote vertebral fusion. Autologous bone grafts, harvested from the patient’s own body, are preferred in many cases due to their high compatibility, reduced rejection risk, and increased success rates in achieving stable fusion. However, autologous grafting also presents challenges, such as the risk of morbidity at the graft site, longer recovery times, and potential for graft resorption. Despite these issues, this approach remains one of the most reliable methods for achieving durable fusion and long-term symptom relief in patients with lumbosacral spondylolisthesis.

While posterior fusion with autologous bone grafting has demonstrated efficacy, its application in Bangladesh presents unique challenges and research gaps. The majority of existing studies on this procedure are based on Western populations with advanced healthcare systems and readily available postoperative care. In contrast, healthcare facilities in Bangladesh often face constraints, including limited resources, variable surgeon expertise, and inconsistencies in postoperative follow-up, all of which may affect patient outcomes [3]. Moreover, socioeconomic factors, such as patients’ access to healthcare, nutritional status, and education level, can also play a significant role in postoperative recovery and fusion success in low-resource settings. These differences underscore the need for region-specific research to establish benchmarks for treatment outcomes and to inform clinical guidelines suited to the Bangladeshi context.A multicenter approach to studying posterior fusion in Bangladesh is particularly valuable because it allows for the collection of a broader and more representative data set. By involving multiple hospitals, this study can account for variability in surgical techniques, hospital facilities, and the diverse patient demographics across different regions of Bangladesh. This multicenter design provides a more comprehensive view of the procedure's effectiveness and could help identify best practices that are adaptable to various settings within the country. Additionally, a multicenter study can reveal critical insights into regional disparities in treatment outcomes, which is essential for tailoring healthcare policies and resource allocation [4]. By exploring these outcomes across diverse patient populations, this research can contribute to a more equitable healthcare model for managing spinal disorders in Bangladesh.

The use of autologous bone grafting in posterior fusion surgeries has been widely endorsed due to its high rates of fusion and biocompatibility, as well as its lack of immunogenic response, which is often a concern with allografts or synthetic graft materials. However, autologous grafting is not without its disadvantages. Donor site morbidity, typically from the iliac crest, can lead to pain and complications, potentially prolonging the patient’s recovery period [5]. Additionally, autologous grafts can sometimes undergo partial resorption before achieving full fusion, which may necessitate secondary interventions. The choice of autologous bone grafting is especially pertinent in the Bangladeshi context, where patients might have limited access to synthetic alternatives due to cost or availability, making this approach both practical and necessary. By evaluating the success of autologous bone grafting in this study, the research will offer valuable insights into the feasibility and challenges of this technique within the country’s healthcare system.Despite the existing evidence supporting posterior fusion, the outcomes of such procedures in low- and middle-income countries like Bangladesh remain understudied. A recent study on spinal surgeries in South Asia highlighted significant postoperative complications linked to delayed diagnosis and limited postoperative care facilities. Furthermore, socio-cultural factors, including patients’ health-seeking behaviors and traditional beliefs about surgical interventions, may influence their adherence to postoperative protocols, potentially impacting recovery [6]. Understanding these influences is crucial for enhancing treatment outcomes and aligning surgical practices with the realities of Bangladeshi healthcare. This study thus seeks to fill the existing research gap by investigating the outcomes of posterior fusion in a Bangladeshi setting, offering contextually relevant data that could inform clinical decision-making and patient counseling.

The primary objective of this multicenter study is to evaluate the effectiveness and outcomes of posterior fusion with autologous bone grafts in treating lumbosacral spondylolisthesis across multiple hospitals in Bangladesh. This research aims to assess the rates of successful fusion, improvement in pain and functional mobility, and the incidence of postoperative complications associated with the procedure. Additionally, the study will explore the influence of patient demographics, such as age, nutritional status, and comorbidities, on surgical outcomes, with a focus on identifying factors that could be optimized to improve patient recovery [7]. By examining these variables, the study hopes to provide healthcare providers with data-driven insights to refine surgical techniques, optimize patient selection, and enhance postoperative care protocols within the Bangladeshi healthcare framework.The study of posterior fusion with autologous bone grafts for treating lumbosacral spondylolisthesis in Bangladesh represents a critical step in addressing spinal health within a resource-limited context. This multicenter approach promises to capture the complexities of surgical outcomes in diverse hospital settings, providing a robust foundation for developing region-specific clinical guidelines. Given the high prevalence of spinal disorders and the limited access to advanced treatment options in Bangladesh, this study has the potential to significantly impact the management of spondylolisthesis and improve quality of life for affected individuals. Through a comprehensive analysis of surgical efficacy, patient outcomes, and healthcare disparities, this research will contribute valuable knowledge to the global field of spinal surgery and provide actionable insights for improving spinal healthcare in Bangladesh.

Aims and Objectives

This study aims to evaluate the effectiveness of posterior fusion with autologous bone grafting in treating lumbosacral spondylolisthesis in Bangladesh. The objective is to assess fusion success rates, pain relief, functional mobility improvements, and complication rates across multiple hospitals, providing insights to optimize treatment outcomes in resource-limited settings.

Study Design This prospective multicenter study was conducted across multiple tertiary-level hospitals in Bangladesh from June 2021 to June 2024. The study involved 358 patients diagnosed with lumbosacral spondylolisthesis who underwent posterior fusion with autologous bone grafting. Patients were followed up at 3, 12, and 24 months post-surgery to assess clinical and radiographic outcomes. Data collection included demographic information, preoperative and postoperative pain scores, functional mobility assessments, and complications observed at each follow-up. Inclusion Criteria The study included patients aged 18–65 years diagnosed with grade I to III lumbosacral spondylolisthesis, as confirmed through clinical and radiographic assessments. Only patients fit for surgery, with no contraindications to spinal fusion, were selected. Patients had to provide informed consent and commit to attending follow-ups over 24 months post-surgery. Exclusion of patients with previous spinal surgeries, active infections, or comorbidities that could impact surgical outcomes ensured a consistent and representative sample for evaluating treatment efficacy. Exclusion Criteria Patients were excluded if they presented with grade IV or higher spondylolisthesis, as these cases may require different surgical techniques. Individuals with severe comorbidities like advanced diabetes, uncontrolled hypertension, or renal impairment, which could affect recovery, were not included. Additionally, patients with poor adherence potential for follow-up, those with active infections, or spinal deformities unrelated to spondylolisthesis were excluded to maintain data reliability. Data Collection Data collection involved gathering preoperative and postoperative clinical data, including pain levels, mobility scores, and radiographic fusion assessments. Patient demographics, nutritional status, and any postoperative complications were documented during each follow-up. All data were recorded in standardized forms across centers to ensure consistency. Data were reviewed and validated at each follow-up to confirm accuracy, with collected information securely stored and de-identified for analysis. Data Analysis Data were analyzed using SPSS version 26.0. Descriptive statistics, including means, standard deviations, and percentages, were used to summarize patient demographics and baseline characteristics. Paired t-tests and chi-square tests evaluated differences in pain and functional mobility scores pre- and post-surgery. Logistic regression analysis identified factors predicting successful fusion and complication risks, accounting for variables such as age, nutritional status, and comorbidities. Statistical significance was set at p < 0.05, with confidence intervals of 95%, providing robust insights into treatment effectiveness. Revision Discectomy Revision discectomy involves surgically removing herniated or damaged disc material from the spine after a previous discectomy. This procedure is typically performed when initial surgery did not alleviate symptoms, or when symptoms recur. It aims to relieve nerve compression, reducing pain and improving mobility. Revision discectomy requires precise handling to minimize tissue disruption and ensure safe, targeted removal of problematic disc material. Posterior Decompression&Fusion with 3D-Metalic Cage This procedure a minimally invasive spinal surgery aimed at treating conditions like spondylolisthesis, spinal stenosis, and degenerative disc disease. The procedure involves decompressing the affected spinal nerves by removing bone or tissue causing pressure, followed by spinal fusion to stabilize the vertebrae. A 3D-printed metallic cage is placed between the vertebrae to promote fusion and enhance stability. The advanced design of the 3D cage mimics the natural curvature of the spine, offering better support and reducing the risk of complications. This technique leads to faster recovery, improved pain relief, and superior long-term outcomes for patients. Post Decompression&Fusion with Autogenous Bone Graft This comprehensive procedure is a surgical approach used to treat spinal disorders such as spondylolisthesis and degenerative disc disease. The procedure begins with decompression, where bone spurs or disc material pressing on the nerves are removed to alleviate pain and improve mobility. Following decompression, spinal fusion is performed using an autogenous bone graft—bone harvested from the patient’s own body, typically from the iliac crest. This graft helps stimulate natural bone growth and ensures strong fusion between vertebrae. The technique provides reliable outcomes with lower risk of graft rejection, promoting long-term spinal stability and function. Ethical Considerations The study was conducted in accordance with ethical standards and received approval from the institutional review boards of each participating hospital. Informed consent was obtained from all patients, detailing the study purpose, procedures, and potential risks. Patient confidentiality was strictly maintained, with data anonymized and stored securely. Ethical guidelines regarding patient safety, data handling, and transparency were strictly adhered to, ensuring compliance with research standards and respect for participant welfare throughout the study.