Background: Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic
lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc
in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar
microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and
instability.
Objectives: We aimed to evaluate the outcomes of OLM and PLELD for antero- and
retrospondylolisthesis with mild slippage and instability.
Study Design: This study used a retrospective design.
Setting: Research was conducted in a hospital and outpatient surgical center.
Methods: This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative
spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our
hospital between March 2007 and August 2014 and who were followed up for at least 3 years.
Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic
parameters, were conducted. Additionally, patients were invited to undergo reexamination to
update their clinical and radiological data.
Results: Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD
groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent
OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among
41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then
underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same
vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%)
who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028).
Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was
associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores,
and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not
differ between OLM and PLELD.
Limitations: The limitations of this study include its relatively small sample size and the possibility
of bias owing to nonrandomized patient selection.
Conclusions: In patients with spondylolisthesis who have a herniated lumbar disc as mild
slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and
mitigate disc degeneration.
IRB approval number: 2016-12-WSH-011
Key words: Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open
lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic
lumbar discectomy, retrospondylolisthesis, slippage
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