In Degenerative Lumbar Spondylolisthesis, Decompression Surgery Not Inferior to Decompression With Instrumented Fusion

2022 ◽  
Vol 28 (1) ◽  
pp. 1-5
Author(s):  
Ellen Hoffmeister
Keyword(s):  
Decompression Surgery ◽  
Instrumented Fusion ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

Radiographic predictors of delayed instability following decompression without fusion for degenerative Grade I lumbar spondylolisthesis

2013 ◽  
Vol 18 (4) ◽  
pp. 340-346 ◽  
Author(s):  
Claire Blumenthal ◽  
Jill Curran ◽  
Edward C. Benzel ◽  
Rachel Potter ◽  
Subu N. Magge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Clinical Decision Making ◽  
Disc Height ◽  
Stepwise Logistic Regression ◽  
Decompression Surgery ◽  
Flexion Extension ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis ◽  
Symptomatic Stenosis

Object It is not known whether adding fusion to lumbar decompression is necessary for all patients undergoing surgery for degenerative lumbar spondylolisthesis with symptomatic stenosis. Determining specific radiographic traits that might predict delayed instability following decompression surgery might guide clinical decision making regarding the utility of up-front fusion in patients with degenerative Grade I spondylolisthesis. Methods Patients with Grade I degenerative lumbar spondylolisthesis (3–14 mm) with symptomatic stenosis were prospectively enrolled from a single site between May 2002 and September 2009 and treated with decompressive laminectomy without fusion. Patients with mechanical back pain or with gross motion (> 3 mm) on flexion-extension lumbar radiographs were excluded. The baseline radiographic variables measured included amount of slippage, disc height, facet angle, motion at spondylolisthesis (flexion-extension), and sagittal rotation angle. Data were analyzed using multivariate forward selection stepwise logistic regression, chi-square tests, Student t-test, and ANOVA. Results Forty patients were enrolled and treated with laminectomy without fusion, and all patients had complete radiographic data sets that were available for analysis. Reoperation was performed in 15 (37.5%) of 40 patients, with a mean follow-up duration of 3.6 years. Reoperation was performed for pain caused by instability at the index level in all 15 cases. Using multivariate stepwise logistic regression with a threshold p value of 0.35, motion at spondylolisthesis, disc height, and facet angle were predictors of reoperation following surgery. Facet angle > 50° was associated with a 39% rate of reoperation, disc height > 6.5 mm was associated with a 45% rate of reoperation, and motion at spondylolisthesis > 1.25 mm was associated with a 54% rate of reoperation. Patients with all 3 risk factors for instability had a 75% rate of reoperation, whereas patients with no risk factors for instability had a 0% rate of reoperation (p = 0.14). Conclusions Patients with motion at spondylolisthesis > 1.25 mm, disc height > 6.5 mm, and facet angle > 50° are more likely to experience instability following decompression surgery for Grade I lumbar spondylolisthesis. Identification of key risk factors for instability might improve patient selection for decompression without fusion surgery. Clinical trial registration no.: NCT00109213

scholarly journals Association of Lumbar Paraspinal Muscle Morphometry with Degenerative Spondylolisthesis

2021 ◽  
Vol 18 (8) ◽  
pp. 4037
Author(s):  
Eun Taek Lee ◽  
Seung Ah Lee ◽  
Yunsoo Soh ◽  
Myung Chul Yoo ◽  
Jun Ho Lee ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Protective Factor ◽  
Degenerative Spondylolisthesis ◽  
Fatty Degeneration ◽  
Erector Spinae ◽  
Cross Sectional ◽  
Skeletal Muscle Index ◽  
Fat Infiltration ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

The objective of this study was to assess the cross-sectional areas (CSA) of lumbar paraspinal muscles and their fatty degeneration in adults with degenerative lumbar spondylolisthesis (DLS) diagnosed with chronic radiculopathy, compare them with those of the same age- and sex-related groups with radiculopathy, and evaluate their correlations and the changes observed on magnetic resonance imaging (MRI). This retrospective study included 62 female patients aged 65–85 years, who were diagnosed with lumbar polyradiculopathy. The patients were divided into two groups: 30 patients with spondylolisthesis and 32 patients without spondylolisthesis. We calculated the CSA and fatty degeneration of the erector spinae (ES) and multifidus (MF) on axial T2-weighted magnetic resonance (MR) images from the inferior end plate of the L4 vertebral body levels. The functional CSA (FCSA): CSA ratio, skeletal muscle index (SMI), and MF CSA: ES CSA ratio were calculated and compared between the two groups using an independent t-test. We performed logistic regression analysis using spondylolisthesis as the dependent variable and SMI, FCSA, rFCSA, fat infiltration rate as independent variables. The result showed more fat infiltration of MF in patients with DLS (56.33 vs. 44.66%; p = 0.001). The mean FCSA (783.33 vs. 666.22 mm2; p = 0.028) of ES muscle was a statistically larger in the patients with DLS. The ES FCSA / total CSA was an independent predictor of lumbar spondylolisthesis (odd ratio =1.092, p = 0.016), while the MF FCSA / total CSA was an independent protective factor (odd ratio =0.898, p = 0.002)

P68. Mid-Term Clinical Outcome of Posterior Decompression Without Fusion for Degenerative Lumbar Spondylolisthesis

2006 ◽  
Vol 6 (5) ◽  
pp. 116S
Author(s):  
Keigo Yasui ◽  
Manabu Ito ◽  
Kuniyoshi Abumi ◽  
Yoshihisa Kotani ◽  
Jun-Ichiro Okumura ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Posterior Decompression ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

scholarly journals Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Comparative Study of 5-Year Outcomes Following Decompression with Fusion and Microendoscopic Decompression

2018 ◽  
Vol 12 (1) ◽  
pp. 132-139 ◽  
Author(s):  
Takato Aihara ◽  
Tomoaki Toyone ◽  
Yasuaki Murata ◽  
Kazuhide Inage ◽  
Makoto Urushibara ◽  
...  
Keyword(s):  
Back Pain ◽  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Large Percentage ◽  
Neutral Position ◽  
Maximal Extension ◽  
Surgical Methods ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Functional Scores ◽  
Lumbar Spondylolisthesis

<sec><title>Study Design</title><p>Retrospective review of prospectively collected outcome data.</p></sec><sec><title>Purpose</title><p>To compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition.</p></sec><sec><title>Overview of Literature</title><p>There have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS.</p></sec><sec><title>Methods</title><p>Forty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.</p></sec><sec><title>Results</title><p>The degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups.</p></sec><sec><title>Conclusions</title><p>MED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.</p></sec>

scholarly journals GUIDELINES FOR TREATMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

2016 ◽  
Vol 15 (3) ◽  
pp. 238-240 ◽  
Author(s):  
CARMEN YOSSALETH BRICEÑO-GONZÁLEZ ◽  
ADRIÁN GARCÍA-SUAREZ ◽  
EULALIO ELIZALDE-MARTÍNEZ ◽  
MARIO ANTONIO DOMÍNGUEZ-DE LA PEÑA ◽  
RUBÉN TORRES-GONZÁLEZ ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Treatment Options ◽  
Cross Sectional ◽  
Practice Guide ◽  
Transpedicular Instrumentation ◽  
Clinical Presentations ◽  
Study Results ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Axial Symptoms ◽  
Lumbar Spondylolisthesis

ABSTRACT Objectives: To determine the standard of treatment of degenerative lumbar spondylolisthesis in its different clinical presentations in UMAE Dr. Victorio de la Fuente Narváez. Methods: Six cases found in the literature were presented to 36 experts in spine surgery, along with treatment options, to thereby obtain a standard prescription for the treatment of degenerative lumbar spondylolisthesis. Analytical observational cross-sectional descriptive study. Results: It was found that the treatment of choice in cases of degenerative lumbar spondylolisthesis with axial symptoms is conservative. The surgical treatment of choice for both stable and unstable patients with radiculopathy and/or claudication is decompression + posterolateral graft + transpedicular instrumentation + discectomy (graft). Conclusions: We managed to define the degenerative lumbar spondylolisthesis treatment guidelines in our unit, which can serve as a basis for the development of a clinical practice guide.

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