Introduction: In the treatment of lumbar stenosis, the best surgical strategy is still a controversial subject especially if spondylolisthesis is present. Although addition of fusion is recommended in such cases, its evidence is not sufficient. From the technical standpoint, we have unilateral laminotomy with bilateral decompression (ULBD) with good mid-term outcome. Therefore, it is legitimate to ask whether we could apply ULBD on patients with spondylolisthesis, and have the same good long-term outcome as in patients without spondylolisthesis. We present our prospective study of ULBD on patients with lumbar stenosis including degenerative spondylolisthesis.
Methods: From 2004 to 2011, 266 patients underwent ULBD for lumbar stenosis, in which 80 had spondylolisthesis. We performed a prospective data acquisition as follows. Patient's status was evaluated using SF-36 questionnaire preoperatively and at regular clinical visits up to 5 years after surgery. Lumbar-spine X-rays were obtained at each visit to evaluate the progress of spondylolisthesis. The average physical score and the bodily pain score of SF-36 were statistically analyzed using multivariate analysis. The rate of re-operation and that of slip progress were evaluated and compared between the two groups.
Results: The average physical score and bodily pain score of SF-36 improved from 31.3 and 25.9 before surgery to 69.1 and 65.2 at 6 months, respectively. This improvement was preserved up to 5 years after surgery. Both scores showed no significant difference between the spondylolisthesis and non-spondylolisthesis group. Progress of slip occurred very rarely: one and two in each group. Reoperation with additional decompression was required in 17 patients, but no fusion surgery was required. The rate of re-operation was not statistically different between the two groups.
Conclusions: ULBD produced the same excellent long-term outcome on patients with spondylolisthesis as on patients without spondylolisthesis.
Patient Care: Our research will give the surgeons an alternative strategy using less-invasive technique for patients with spondylolisthesis, the effectiveness of which is supported by good statistical evidence.
Learning Objectives: By the conclusion of this session, participants should be able to identify an effective treatment on lumbar stenosis associated with degenerative spondylolisthesis.