Comparison of Decompression, Decompression Plus Fusion, and Decompression Plus Stabilization for Degenerative Spondylolisthesis

Abstract

Study Design:This is a prospective, randomized controlled trial.Objective:To prospectively assess the long-term clinical results of decompression alone, decompression plus fusion, and decompression plus stabilization for degenerative spondylolisthesis.Summary of Background Data:Symptoms of lumbar spinal stenosis due to degenerative spondylolisthesis originate from compression of the dural sac or nerve root. Essentially, this condition is treated by performing a decompression of neural structures. Posterolateral lumbar fusion and posterior pedicle-based dynamic stabilization are additional techniques performed to ensure improved prognosis. However, to date, the selection of a surgical procedure for lumbar spinal stenosis due to degenerative spondylolisthesis remains debatable, especially in terms of the addition of instrumentation because of the few available prospective, randomized studies.Materials and Methods:We randomly assigned patients who had 1 level lumbar spinal stenosis due to degenerative spondylolisthesis at the L4/5 level to undergo either decompression alone (decompression group), decompression plus fusion (fusion group), or decompression plus stabilization (stabilization group). Outcomes were assessed using the Japanese Orthopaedic Association and Visual Analogue Scale scores.Results:In total, 85 patients underwent randomization. The follow-up rate at 5 years was 86.4%. The fusion and stabilization groups showed higher blood loss and a longer operative time than the decompression group. The fusion group showed longer postoperative hospital stay than the decompression group. In terms of clinical outcomes, all scores significantly improved postoperatively, and these outcomes were maintained at 5 years postoperatively in each group. There were no significant differences among the groups at 1 and 5 years postoperatively.Conclusions:Additional instrumentation operation for low-grade (<30%) degenerative spondylolisthesis did not result in superior results to decompression alone at 1 and 5 years postoperatively.Level of Evidence:Level II.

The biomechanical effect of single-level laminectomy and posterior instrumentation on spinal stability in degenerative lumbar scoliosis: a human cadaveric study

“…38 Similarly, in randomized controlled trials of patients with lumbar spinal canal stenosis, with or without degenerative spondylolisthesis, decompressive surgery followed by the placement of posterior instrumentation did not result in better clinical outcomes after 2 and 5 years of follow-up than decompressive surgery alone. 23,36,39 Notably, Daubs et al compared the duration of the symptom-free results after decompression alone with decompression and fusion surgery in patients with mild degenerative lumbar scoliosis (< 30°) and stenosis after long periods of time. At 5 years postoperatively, 12 (75%) of the 16 patients in the decompression-alone group developed recurrent stenosis versus only 14 (36%) of 39 patients in the decompression and fusion group (p = 0.016).…”

“…Since degeneration is a slowly occurring process, progressive instability might develop over time after decompression, and thus, long-term changes are clinically important as well, such as shown by the previously mentioned study by Daubs et al 19 However, several clinical studies with up to 5 years of follow-up show good clinical outcome, which suggests that the immediate effect of the surgical procedures by directly altering spinal biomechanics is greater than the slow effect of end-stage degeneration. 23,36,39 For posterior instrumentation, there were screws placed in L2 and L4, which were connected with bilateral rods. No screws were placed in L3, as this would increase the difficulty of placing the rods in the screws at this level due to the variety in Cobb angle of the lumbar spines.…”

Efficacy of percutaneous transforaminal endoscopic decompression treatment for degenerative lumbar spondylolisthesis with spinal stenosis in elderly patients

“…The focus of controversy was whether the addition of fusion added benefit to decompression for patients with either grade I or II spondylolisthesis spondylolisthesis. Increasing evidence has demonstrated that in the management of DLS associated with spinal stenosis, additional fusion may not yield any clinical improvement over treatment with decompression alone (5)(6)(7).…”

A Guide to the Language of Clinical Outcome Assessment

“…Any of the following complications: Dural tear, delusion, hematoma, meralgia, pulmonary embolism, misplacement of pedicle screw 11…”