Neurogenic claudication secondary to degenerative spondylolisthesis: is fusion always necessary?

Kitchen, William John; Mohamed, Mohamed; Bhojak, Manesh; Wilby, Martin

doi:10.1080/02688697.2016.1206181

Cited by 9 publications

(8 citation statements)

References 10 publications

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“…In contrast to previously published studies, 3,16 our analysis did not show any correlation between disc height and instability. We speculate that the small number of patients in our study or the different assessment tool (MRI vs radiography) may explain this finding.…”

Section: Discussioncontrasting

confidence: 99%

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

Kern

Setzer

Weise

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe treatment of patients with spinal stenosis and concurrent degenerative spondylolisthesis is controversial. Two large randomized controlled clinical trials reported contradictory results. The authors hypothesized that a substantial number of patients will show evidence of micro-instability after a sole decompression procedure.METHODSThis study was a retrospective analysis of all cases of lumbar spinal stenosis treated at the Frankfurt University Clinic (Universitätsklinik Frankfurt) from 2010 through 2013. Patients who had associated spondylolisthesis underwent upright MRI studies in flexion and extension for identification of subtle signs of micro-instability. Clinical outcome was assessed by means of SF-36 bodily pain (BP) and physical functioning (PF) scales.RESULTSA total of 21 patients were recruited to undergo upright MRI studies. The mean duration of follow-up was 65 months (SD 16 months). Of these 21 patients, 10 (47%) showed signs of micro-instability as defined by movement of > 4 mm on flexion/extension MRI. Comparison of mean SF-36 BP and PF scores in the group of patients who showed micro-instability versus those who did not showed no statistically significant difference on either scale.CONCLUSIONSThere seems to be a substantial subset of patients who develop morphological micro-instability after sole decompression procedures but do not experience any clinically significant effect of the instability.

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Section: Discussioncontrasting

confidence: 99%

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

Kern

Setzer

Weise

et al. 2019

Neurosurgical Focus

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“…Finally, three recent non-comparative cohort studies have also demonstrated safety and efficacy of spinal decompression in populations with low-grade spondylolisthesis with spinal stenosis [19][20][21]. In these studies at long-term follow-up, patients had improvements in ODI, EuroQol Five Dimensions (EQ-5D), or visual analogue scale (VAS) for back and leg pain scores.…”

Section: Surgical Decompressionmentioning

confidence: 98%

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Samuel

Moore

Cunningham

2017

Curr Rev Musculoskelet Med

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There is some moderate evidence that decompression alone may be a feasible treatment with lower surgical morbidity and similar outcomes to fusion when performed in a select population with a low-grade slip. Similarly, addition of interbody fusion may be best suited to a subset of patients with high-grade degenerative spondylolisthesis, although this remains controversial. Minimally invasive techniques are increasingly being utilized for both decompression and fusion surgeries with more and more studies showing similar outcomes and lower postoperative morbidity for patients. This will likely be an area of continued intense research. Finally, the role of spondylolisthesis reduction will likely be determined as further investigation into optimal sagittal balance and spinopelvic parameters is conducted. Future identification of ideal thresholds for sagittal vertical axis and slip angle that will prevent progression and reoperation will play an important role in surgical treatment planning. Current evidence supports surgical treatment of degenerative spondylolisthesis. While posterolateral spinal fusion remains the treatment of choice, the use of interbodies and decompressions without fusion may be efficacious in certain populations. However, additional high-quality evidence is needed, especially in newer areas of practice such as minimally invasive techniques and sagittal balance correction.

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“…The eligible cases were those (6) patients who had DLS and received surgical treatment in the period of 2003-2013 at the Neurosurgical Division, Surgery Department, Faculty of Medicine of Ramathibodi Hospital. Surgery was carried out on those patients who were suffering from back pain, radicular pain, or neurological claudication even after 3 months of conservative management (18). A total of 25 men and 75 women having an average age of 61 years were recruited.…”

Section: Subjectsmentioning

confidence: 99%

“…It seldom occurs before the age of 50 years and is approximately four times more prevalent in women than in men (15). Its features include spinal stenosis with an anterior translation not exceeding 30% of the width of the vertebral body (18). DLS patients may suffer from back and leg pain.…”

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confidence: 99%

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Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

Chumnanvej

Segkhaphant²

2018

Turkish Neurosurgery

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be elucidated (1,7,33). Thus, the objective parameters such as spinopelvic parameters are required (9,11,29). Since spinopelvic parameters are intricately associated with the deformity, changes in spinopelvic parameters can be objectively determined after correction of the deformity (10,17,23,25,28,38). Several studies have proposed methods for determination of spinopelvic parameters after surgical correction for DLS (2-5,

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Neurogenic claudication secondary to degenerative spondylolisthesis: is fusion always necessary?

Cited by 9 publications

References 10 publications

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

Upright MRI after decompression of spinal stenosis and concurrent spondylolisthesis

Treatment for Degenerative Lumbar Spondylolisthesis: Current Concepts and New Evidence

Determination of spinopelvic parameters in degenerative lumbar spondylolisthesis patients undergoing lumbosacral spine fusion surgery: the lesson learnt

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