Decompression and Dynamic Transpedicular Stabilization Using Polyetheretherketone Rods and Pedicle Screws vs. Decompression Alone for Single-Level Spinal Canal Stenosis with Listhesis: A Retrospective Case-Control Study

Abstract

Background Spinal stenosis is frequently caused by spondylolisthesis, and surgical treatment may be indicated. However, whether decompression alone or decompression with dynamic stabilization offers better surgical outcomes remains unclear. We compared the clinical and radiologic results of patients with single-level lumbar spinal stenosis and grade 1 spondylolisthesis undergoing microsurgical decompression alone or decompression with transpedicular dorsal dynamic stabilization. Methods We retrospectively analyzed 20 patients undergoing microsurgical decompression and dorsal dynamic transpedicular stabilization using polyetheretherketone (PEEK) rods in one center from 2011 to 2017. Twenty patients with the same diagnosis undergoing microsurgical decompression alone were used as controls. Reoperation of the index and neighboring segments, back/leg pain, neurologic deficits, and the use of pain medication were assessed. For stabilization patients, radiographic progression of degeneration in the neighboring segments, listhesis degree in the index segment, and implant failure were assessed. Results All patients had good clinical outcomes at 3 and 12 months postoperatively. In stabilization patients, the visual analog scale (VAS) score for leg pain decreased from 5 points (median) to 1.6 at 3 months and 0.6 at 1 year postoperatively. In controls, the VAS score improved from 4.8 points to 1.1 at 3 months and 0.3 at 1 year postoperatively. The VAS score for back pain in stabilization patients decreased from 7.6 points (median) to 1.7 at 3 months and 0.1 at 1 year postoperatively. In controls, it decreased from 7.7 points to 1.1 at 3 months and 0.2 at 1 year postoperatively. In patients with additional dynamic stabilization, a longer hospital stay (stabilization group: 8.7 ± 4.1; control: 6.2 ± 1.6 days), longer operative time (stabilization group: 132.7 ± 41.3; control: 83.2 ± 31.7 minutes), and higher complication rates (revision surgery performed in two stabilization patients) were found. Conclusion No indications in our study showed that additional dynamic stabilization with PEEK rods offers any advantage over decompression alone.

Facet Joint Replacement: Intermediate- and Long-Term Outcome in a Large Case Series

“…15 This seems to be true also for dynamic fusion. 16 FJR primarily aims for facet joint pathology, which may cause spinal claudication by stenosis of the spinal canal or nerve root compromise by foraminal stenosis. We would use FJR for symptomatic spinal canal stenosis (as the sole symptom) caused exclusively by facet joint hypertrophy, only if after analysis of the individual pathologic anatomy of the facet joints segmental instability would be expected by decompression.…”

“…Between posterior dynamic devices (e.g., flexible rod-based implants) and FJR, there is a conceptual overlap. 10,16 FJR offers the possibility to remove the generator of facet pain completely, to decompress effectively the upper foramen and the spinal canal. Moreover, FJR is able to compensate minor spondylolisthesis and improve spinal alignment.…”