Minimally invasive decompression in patients with degenerative spondylolisthesis associated with lumbar spinal stenosis. Report of a surgical series and review of the literature

Abstract

We reported the results of minimally invasive spinal decompression (MISD) in patients with degenerative spondylolisthesis (DS) associated with lumbar spinal stenosis (LSS) and performed a literature review in order to evaluate the clinical and radiological outcomes, the complications and reoperation rate of MISD procedures in these patients. Data of 28 patients submitted to MISD for DS associated to LSS were reviewed. We evaluated the Visual Analogue Scale (VAS) both for low back pain (LBP) and legs pain, the Oswestry Disability Index (ODI) and the degree of the slippage. A PubMed search of the English literature was conducted. Only papers with more than 10 patients and reporting explicitly data of patients with DS were included in the analysis. We found a statistically significant improvement of LBP, legs pain and ODI in our series. The degree of slippage was stable at follow-up (FU) with no need of reoperation. No major complications occurred. In our literature review, we were able to analyze the differences in ODI in 156 patients and the differences in Japanese Orthopedic Association (JOA) score in 218 patients. We observed a statistically significant improvement of ODI and JOA score at FU compared to pre-operative. The percentage of slippage, evaluated in 283 patients, was unchanged at FU compared to pre-operative. The overall complication rate was 1.6%. The overall reoperation rate was 4.5%. MISD procedures are safe and effective in patients with DS associated to LSS and are associated to low morbidity and significant improvement of disability without progression of slippage.

A Systematic Review of Complications Following Minimally Invasive Spine Surgery Including Transforaminal Lumbar Interbody Fusion

“…Rahman [53]. A systematic review describing MISD for degenerative spondylolisthesis found an overall complication rate of 1.6% and an overall reoperation rate of 4.5% [55]. Another systematic review exploring minimally invasive discectomy versus microdiscectomy and open discectomy in lumbar disc herniation cases found lower rates of surgical site infections and urinary tract infections, yet higher rates of rehospitalization for recurrent disc herniation [56].…”

<p>Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Central Spinal Stenosis and Degenerative Lumbar Spondylolisthesis: A Novel Surgical Technique and Clinical Outcomes</p>

“…When conservative treatment thoroughly fails, surgical treatment is considered. 2 Traditionally, decompression with instrumented fusion procedures has been performed for patients with neurogenic claudication and nerve root compression. Ghogawala et al 3 concluded that among patients with DLS, the addition of fusion was associated with significant improvements in quality of life compared with decompression alone.…”

Change of Clinical and Radiologic Parameters after Minimally Invasive Decompression in Patients with Lumbar Spinal Stenosis: A Prospective Study with Long-term Follow-up

“…We prospectively collected the clinical and radiological data of 24 consecutive patients (16 F, 8 M) submitted to MID 18 for the treatment of lumbar spinal stenosis (LSS), from January 2019 to March…”

“…We prospectively collected the clinical and radiologic data of 24 consecutive patients (16 females and 8 males) submitted to MID 18 for the treatment of LSS, from January to March 2019. One of the patients declined after reading the informed consent, two patients were excluded because they were affected by rheumatic disorder (polymyalgia rheumatic), and one was affected by lumbar spondylolisthesis.…”

“…12,14 MID has been proved as a viable option in treatment of LSS, even when associated with degenerative spondylolisthesis. 18 Given the morbidity and the cost of spinal fusion surgery and the growing attention about minimally invasive techniques, improving knowledge on the relationship between the sagittal alignment and MID in treatment of LSS is an unmet need in spine surgery. In the last decade, several Authors investigated the sagittal alignment and compensatory mechanisms in patients with lumbar degenerative disease (LDD).…”