Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.

Herkowitz, Harry N.; Kurz, Lawrence T.

doi:10.2106/00004623-199173060-00002

Cited by 939 publications

(492 citation statements)

References 13 publications

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“…Fusion prevents segmental instability derived from the underlying disorder or decompression (postdiscectomy or postlaminectomy instability) [10,29,43] and allows surgeons to perform wider discectomies, laminectomies and facetectomies. Nevertheless, the published results on spinal fusion and on pedicle [8,25,26,35,49] and interbody implants [9,24] differ depending on the authors and have been controversial in terms of efficacy, complication rates [17,18] or cost-benefit ratio [35,38].…”

Section: Introductionmentioning

confidence: 99%

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Soriano

Revuelta²,

Fabregate

et al. 2010

Eur Spine J

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There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of ''disc herniation'', less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.

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Section: Introductionmentioning

confidence: 99%

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Soriano

Revuelta²,

Fabregate

et al. 2010

Eur Spine J

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“…In the absence of preexisting spinal instability, arthrodesis is unnecessary after decompression of lumbar spine for canal stenosis. No difference was found in the improvement of walking distance and relief of pain (followup more than 2 years) in patients who had decompression alone or decompression with fusion 1121–2527–29…”

Section: Discussionmentioning

confidence: 90%

“…It is a common spinal problem in people over the age of 65 years. Surgery is required with increasing frequency in such patients 15–21. The incidence of postoperative (5–10 years) instability after extensive decompressive laminectomy is reported as 3–20% 7–10.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of postoperative (5–10 years) instability after extensive decompressive laminectomy is reported as 3–20% 7–10. Many workers have combined extensive laminectomy with fusion with or without instrumented stabilization 21–24. However, there is no convincing evidence to suggest that concomitant fusion has increased patients’ satisfaction 25–29.…”

Section: Discussionmentioning

confidence: 99%

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Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

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Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

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“…However, the optimal surgical treatment in patients suffering from symptomatic lumbar stenosis, who also have degenerative spondylolisthesis, has long been a subject of debate. Decompression without fusion for lumbar stenosis in the presence of degenerative spondylolisthesis has been associated with postoperative instability of the spine [5][6][7][8][9][10]. This postoperative instability is presumed to be the result of the removal of the posterior elements, such as the spinous process, inter-and supraspinous ligaments and medial aspect of the facet joints.…”

Section: Introductionmentioning

confidence: 99%

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

et al. 2018

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Purpose The primary objective of this systematic review is to compare the outcome after decompression with and without concomitant instrumented fusion in patients with lumbar stenosis and degenerative spondylolisthesis. Does adding fusion to simple decompression lead to better results? Methods PubMed, Embase, CENTRAL, Cochrane, Web of Science, CINAHL and Academic Search Premier were searched. All studies comparing outcome of decompression alone to decompression with concomitant-instrumented fusion in patients suffering from symptomatic lumbar stenosis with degenerative spondylolisthesis were included. Risk of bias was assessed using an adapted version of the Cowley checklist. Results Eleven studies were included in the analysis involving 3119 patients in total. In the majority of studies, including two RCTs, clinical outcome of both patient groups was comparable regarding most clinical outcome measures. Conclusion Currently there is not enough evidence that adding instrumented fusion to a decompression leads to superior outcomes compared to decompression only in patients with lumbar stenosis and degenerative spondylolisthesis. The most important clinical outcome measures, including the ODI, show comparable results. Therefore, the least invasive and least costly procedure, being decompression alone, is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Take Home Messages 1. Adding fusion to a decompression does not lead to better outcomes regarding the ODI and leg pain. Graphical abstract2. Decompression with concomitant fusion is presumably associated with more complications compared to decompression alone.3. Decompression alone is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Forsth, P., et al. (2013). Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J 95-B(7): 960-965 Forsth, P., et al. (2016). A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis.

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Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.

Cited by 939 publications

References 13 publications

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

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