Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Decompression without fusion for degenerative lumbar stenosis is an effective treatment for both the pain and disability of neurogenic claudication. Iatrogenic instability following decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar decompression, and assess the impact of surgical technique as well as study design on the incidence of instability.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar stenosis, with and without preexisting spondylolisthesis, who were treated with laminectomy or minimally invasive decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A systematic review of 24 studies involving 2496 patients was performed, assessing both open laminectomy and minimally invasive bilateral canal enlargement. Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting spondylolisthesis (12.6%) and in those treated with open laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative spondylolisthesis (9.3%) and for those treated with open laminectomy (4.1%).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Instability following lumbar decompression is a common occurrence. This is particularly true if decompression alone is selected as a surgical approach in patients with established spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.</jats:p></jats:sec>

Study-protocol for a randomized controlled trial comparing clinical and radiological results after three different posterior decompression techniques for lumbar spinal stenosis: the Spinal Stenosis Trial (SST) (part of the NORDSTEN Study)

“…Development or progression of postoperative instability after posterior decompression for lumbar spinal stenosis is still considered as an important complication [9]. Whether one of the three methods is more prone to postoperative instability is also a factor that will be investigated in the present trial.…”

Technical Nuances of Minimal Invasive Interlaminar Decompression in Lumbar Spinal Stenosis: The Role of Minimal Invasive Bilateral Approach

“…The most common approach is an open laminectomy with medial facetectomy and foraminotomy [1]- [3], which provides wide decompression but involves wide muscle retraction and extensive removal of posterior spinal structures, which can lead to lumbar instability [15]. Indeed, a recent systematic review established that iatrogenic spondylolisthesis following laminectomy is a common condition often requiring reoperation for the instability [7]. Thus lumbar fusion with instrumentation is commonly used following decompression for stenosis associated with spondylolisthesis [16].…”

“…The most common technique is open laminectomy [1]- [3], which has been shown to improve quality-of-life outcomes compared to conservative therapy [4]- [6]. Nonetheless, this procedure can be associated to iatrogenic instability requiring reoperation to perform lumbar fusion by instrumentation [7]. Minimal invasive procedures such as the muscle-preserving interlaminar decompression (MILD) [8] and the unilateral approach for bilateral decompression (ULBD) [9] have been reported in the literature [10]- [12] as alternative techniques for lumbar spinal stenosis decompression.…”

Minimally invasive techniques for lumbar decompressions and fusions

“…In regards to reoperation risk, reported rates after MIS LD fall between 0.0-7.0% [11••, 19, 21, 22, 25, 26, 28]. Guha et al, in another meta-analysis comparing cohorts undergoing either open or MIS LD, determined that the reoperation risk was higher in patients undergoing open procedures [21]. The authors claimed that this difference was primarily a result of the increased development of postoperative spondylolisthesis in the open cohort.…”