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A comparison of unilateral laminectomy with bilateral decompression and fusion surgery in the treatment of grade I lumbar degenerative spondylolisthesis

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Abstract

Background

Although unilateral laminectomy and bilateral decompression (ULBD) is effective in the treatment of degenerative spondylolisthesis (DSPL), few reports have compared the outcomes of ULBD and instrumented fusion for the treatment of DSPL. We describe here the clinical and radiological outcomes of ULBD and instrumented fusion surgery for the treatment of DSPL after a minimum 3-year follow-up.

Methods

We retrospectively analyzed the outcomes of 47 DSPL patients with radicular pain who underwent ULBD or instrumented fusion between January 2005 and December 2007. Clinical outcomes were assessed using the numeric rating scale (NRS) for back and leg pain, the Oswestry Disability Index (ODI), and Short Form-36 Health Survey (SF-36). Radiological outcomes of ULBD were analyzed by determining changes in slippage, disc height translation, and angular difference on simple and dynamic X-rays.

Results

The mean NRS of back pain showed a significantly greater decrease in the fusion than the ULBD group, whereas the mean NRS of leg pain, mean ODI, and mean physical component summary and mental component summary of the SF-36 decreased similarly in the ULBD and fusion groups. Radiologically, the ULBD group showed a 2.1 ± 3.10% change in mean slippage, a 0.15 ± 1.58 mm change in mean translation, a -0.91 ± 4.48° change in mean angular difference, and a -1.83 ± 1.69 mm change in mean disc height. In the ULBD group, three patients had residual pain and three had recurrent pain. In comparison, no patient in the fusion group reported residual pain, whereas five patients experienced recurrent radicular pain caused by adjacent segmental disease.

Conclusions

Our findings suggest that ULBD is the recommendable procedure for the treatment of patients with grade I DSPL who have mainly radicular pain. Although the two groups showed similar clinical outcomes overall, radiological degeneration was not as serious after ULBD treatment. In our analysis, foraminal stenosis is a contraindication for ULBD in the treatment of grade I DSPL.

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References

  1. Booth KC, Bridwell KH, Eisenberg BA, Baldus CR, Lenke LG (1999) Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion. Spine 24(16):1721–1727

    Article  PubMed  CAS  Google Scholar 

  2. Bridwell KH, Sedgewick TA, O’Brien MF, Lenke LG, Baldus C (1993) The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 6(6):461–472

    Article  PubMed  CAS  Google Scholar 

  3. Çavuşoğlu H, Kaya RA, Türkmenoglu ON, Tuncer C, Çolak İ, Aydın Y (2007) Midterm outcome after unilateral approach for bilateral decompression of lumbar spinal stenosis: 5-year prospective study. Eur Spine J 16(12):2133–2142

    Article  PubMed  Google Scholar 

  4. Cinotti G, Postacchini F, Fassari F, Urso S (1997) Predisposing factors in degenerative spondylolisthesis. A radiographic and CT study. Int Orthop 21(5):337–342

    Article  PubMed  CAS  Google Scholar 

  5. Costa F, Sassi M, Cardia A, Ortolina A, De Santis A, Luccarell G, Fornari M (2007) Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression. J Neurosurg Spine 7(6):579–586

    Article  PubMed  Google Scholar 

  6. Epstein NE (1998) Decompression in the surgical management of degenerative spondylolisthesis: advantages of a conservative approach in 290 patients. J Spinal Disord 11(2):116–123

    Article  PubMed  CAS  Google Scholar 

  7. Epstein NE (2002) Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 40(10):491–500

    Article  PubMed  CAS  Google Scholar 

  8. Feffer HL, Wiesel SW, Cuckler JM, Rothman RH (1985) Degenerative spondylolisthesis. To fuse or not to fuse. Spine 10(3):287–289

    Article  PubMed  CAS  Google Scholar 

  9. Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 22(24):2807–2812

    Article  PubMed  CAS  Google Scholar 

  10. Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG, Harrington JF, Magge SN, Strugar J, Coumans JV, Borges LF (2004) Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg Spine 1(3):267–272

    Article  PubMed  Google Scholar 

  11. Grobler LJ, Robertson PA, Novotny JE, Ahern JW (1993) Decompression for degenerative spondylolisthesis and spinal stenosis at L4-5. The effects on facet joint morphology. Spine 18(11):1475–1482

    PubMed  CAS  Google Scholar 

  12. Herkowitz HN (1995) Spine update. Degenerative lumbar spondylolisthesis. Spine 20(9):1084–1090

    Article  PubMed  CAS  Google Scholar 

  13. Herkowitz HN, Kurz LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 73(6):802–808

    PubMed  CAS  Google Scholar 

  14. Herron LD, Trippi AC (1989) L4-5 degenerative spondylolisthesis. The results of treatment by decompressive laminectomy without fusion. Spine 14(5):534–538

    Article  PubMed  CAS  Google Scholar 

  15. Kettler A, Wilke HJ (2006) Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 15(6):705–718

    Article  PubMed  Google Scholar 

  16. Konno S, Kikuchi S (2000) Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with graf system stabilization. Spine 25(12):1533–1537

    Article  PubMed  CAS  Google Scholar 

  17. Kristof RA, Aliashkevich AF, Schuster M, Meyer B, Urbach H, Schramm J (2002) Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. J Neurosurg 97(3 Suppl):281–286

    PubMed  Google Scholar 

  18. Mardjetko SM, Connolly PJ, Shott S (1994) Degenerative lumbar spondylolisthesis. A meta-analysis of literature 1970-1993. Spine 19(20 Suppl):2256S–2265S

    Article  PubMed  CAS  Google Scholar 

  19. Matsunaga S, Sakou T, Morizono Y, Masuda A, Demirtas AM (1990) Natural history of degenerative spondylolisthesis. Pathogenesis and natural course of the slippage. Spine 15(11):1204–1210

    Article  PubMed  CAS  Google Scholar 

  20. McCulloch JA (1998) Microdecompression and uninstrumented single-level fusion for spinal canal stenosis with degenerative spondylolisthesis. Spine 23(20):2243–2252

    Article  PubMed  CAS  Google Scholar 

  21. McCulloch JA, Young PA (1998) Essentials of spinal microsurgery. Lippincott-Raven, Philadelphia

    Google Scholar 

  22. Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A (1994) Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine 19(12):1371–1380

    Article  PubMed  CAS  Google Scholar 

  23. Mochida J, Suzuki K, Chiba M (1999) How to stabilize a single level lesion of degenerative lumbar spondylolisthesis. Clin Orthop Relat Res 368:126–134

    Article  PubMed  Google Scholar 

  24. Niggemeyer O, Strauss JM, Schulitz KP (1997) Comparison of surgical procedures for degenerative lumbar spinal stenosis: a meta-analysis of the literature from 1975 to 1995. Eur Spine J 6(6):423–429

    Article  PubMed  CAS  Google Scholar 

  25. Nork SE, Hu SS, Workman KL, Glazer PA, Bradford DS (1999) Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis. Spine 24(6):561–569

    Article  PubMed  CAS  Google Scholar 

  26. Oertel MF, Ryang Y-M, Korinth MC, Gilsbach JM, Rohde V (2006) Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression. Neurosurgery 59(6):1264–1270

    Article  PubMed  Google Scholar 

  27. Palmer S, Turner R, Palmer R (2002) Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system. Neurosurg Focus 13(1):E4

    Article  PubMed  Google Scholar 

  28. Papavero L, Thiel M, Fritzsche E, Kunze C, Westphal M, Kothe R (2009) Lumbar spinal stenosis: prognostic factors for bilateral microsurgical decompression using a unilateral approach. Neurosurgery 65(6 Suppl):182–187

    PubMed  Google Scholar 

  29. Park JH, Bae CW, Jeon SR, Rhim SC, Kim CJ, Roh SW (2010) Clinical and radiological outcomes of unilateral facetectomy and interbody fusion using expandable cages for lumbosacral foraminal stenosis. J Korean Neurosurg Soc 48(6):496–500

    Article  PubMed  CAS  Google Scholar 

  30. Poletti C (1995) Central lumbar stenosis caused by ligamentum flavum:unilateral laminotomy for bilateral ligamentectomy: preliminary report of two cases. Neurosurg 37:343–347

    Article  CAS  Google Scholar 

  31. Sasai K, Umeda M, Maruyama T, Wakabayashi E, Iida H (2008) Microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis including degenerative spondylolisthesis. J Neurosurg Spine 9(6):554–559

    Article  PubMed  Google Scholar 

  32. Sengupta DK, Herkowitz HN (2003) Lumbar spinal stenosis. Treatment strategies and indications for surgery. Orthop Clin North Am 34(2):281–295

    Article  PubMed  Google Scholar 

  33. Spetzger U, Bertalanffy H, Reinges MH, Gilsbach JM (1997) Unilateral laminotomy for bilateral decompression of lumbar spinal stenosis. Part II: Clinical experiences. Acta Neurochir (Wein) 139(5):397–403

    Article  CAS  Google Scholar 

  34. Toyoda H, Nakamura H, Konishi S, Dohzono S, Kato M, Matsuda H (2011) Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis: minimum five-year follow-up. Spine 36(5):410–415

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2dong, Songpa-gu, Seoul, 138-736, Korea

    Sung Woo Roh & Seung Chul Rhim

  2. Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam, Korea

    Seung-Jae Hyun

  3. Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

    Jin Hoon Park

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  1. Jin Hoon Park
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  2. Seung-Jae Hyun
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Correspondence to Seung Chul Rhim.

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Park, J.H., Hyun, SJ., Roh, S.W. et al. A comparison of unilateral laminectomy with bilateral decompression and fusion surgery in the treatment of grade I lumbar degenerative spondylolisthesis. Acta Neurochir 154, 1205–1212 (2012). https://doi.org/10.1007/s00701-012-1394-1

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