+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Lumbar Degenerative Spondylolisthesis: Changes in Surgical Indications and Comparison of Instrumented Fusion With Two Surgical Decompression Procedures

Lumbar Degenerative Spondylolisthesis: Changes in Surgical Indications and Comparison of Instrumented Fusion With Two Surgical Decompression Procedures

Spine 42(1): E15-E24

Single-center retrospective case series. To compare outcomes of instrumented fusion and two methods of decompression for degenerative spondylolisthesis. There is no consensus on the surgical indications or optimum techniques for lumbar degenerative spondylolisthesis. We analyzed the data of 140 patients treated by fusion (n = 80; mean follow-up, 77.9 months) or decompression (n = 60; mean follow-up, 38.0 months) and examined changes in surgical indications over a 12-year period. We compared the outcomes of instrumented fusion with the outcomes of two decompression techniques, the first employing a unilateral approach for bilateral decompression and the second employing a bilateral approach for contralateral decompression, with contralateral foraminal decompression as needed. Postoperative evaluation was made at the final follow-up visit beginning in 2007 by analyzing patient interviews and neurological examination data. We compared results with the Japanese Orthopedic Association symptom score before surgery and at final follow-up. Surgical indications for fusion narrowed over time, with fusion used less frequently and decompression used more frequently. Similar decreases in clinical symptoms, including low back pain, were achieved with all methods. In the decompression groups, preoperative slip distance and instability, and postoperative slip progression or development of instability, did not correlate significantly with clinical outcome. Slip progression occurred in 8 of 10 levels in patients with preoperative translation ≥5 mm, but these patients showed no increase in instability, defined as translation ≥ 2 mm, at final follow-up. Our findings raise a question about the value of the radiologic criteria for performing fusion used in the late period, namely translation ≥5 mm and/or rotation ≥ 10°. If discogenic pain is excluded, decompression alone may be suitable even for patients with severe low back pain and translation ≥5 mm. 4.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 058245426

Download citation: RISBibTeXText

PMID: 27196020

DOI: 10.1097/BRS.0000000000001688

Related references

Comparison of functional outcomes following surgical decompression and posterolateral instrumented fusion in single level low grade lumbar degenerative versus isthmic spondylolisthesis. Clinics in Orthopedic Surgery 6(2): 185-189, 2015

Surgical treatment of symptomatic degenerative lumbar spondylolisthesis by decompression and instrumented fusion. Journal of Orthopaedics and Traumatology 8(3): 128-133, 2007

Surgical Outcome of Reduction and Instrumented Fusion in Lumbar Degenerative Spondylolisthesis. Iranian Journal of Medical Sciences 41(1): 13-18, 2016

Comparison study of the instrumented circumferential fusion with instrumented anterior lumbar interbody fusion as a surgical procedure for adult low-grade isthmic spondylolisthesis. World Neurosurgery 73(5): 565-571, 2010

Surgical treatment of adult degenerative spondylolisthesis by instrumented transforaminal lumbar interbody fusion in the Han nationality. Journal of Neurosurgery. Spine 10(5): 496-499, 2009

Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis. Asian Spine Journal 10(1): 27-37, 2016

Clinical and Radiological Comparison between Three Different Minimally Invasive Surgical Fusion Techniques for Single-Level Lumbar Isthmic and Degenerative Spondylolisthesis: Minimally Invasive Surgical Posterolateral Fusion versus Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion versus Midline Lumbar Fusion. Asian Spine Journal 12(5): 870-879, 2018

Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. Journal of Neurosurgery. Spine 1(3): 267-272, 2004

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: fusion following decompression in patients with stenosis without spondylolisthesis. Journal of Neurosurgery. Spine 2(6): 686-691, 2005

Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. European Spine Journal 17(8): 1107-1112, 2008

Surgical outcomes of degenerative spondylolisthesis with L5-S1 disc degeneration: comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up. Spine 36(19): 1600-1607, 2012

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurgical Focus 46(5): E13, 2019

A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy. Neurosurgical Focus 40(6): E7, 2017

Comparison of instrumented posterior fusion with instrumented circumferential lumbar fusion in the treatment of lumbar stenosis with low degree lumbar spondylolisthesis. Zhonghua Wai Ke Za Zhi 43(8): 486-490, 2005

Combined anterior lumbar interbody fusion and instrumented posterolateral fusion for degenerative lumbar scoliosis: indication and surgical outcomes. Bmc Surgery 15: 26, 2016