Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone

Abstract

One hundred twenty-four patients with degenerative lumbar stenosis underwent decompression with fusion (32 patients) and without fusion (92 patients) during a 30-month period between 1986 and 1988. Patient-reported satisfaction at a mean follow-up period of 5.8 years (range 4.6-6.8 years) revealed a 79% good or fair outcome and a 21% poor outcome (26 patients). Seven patients (6%) developed lumbar instability, three patients (2%) developed new stenosis at an adjacent unoperated level, and three patients (2%) developed a new disc herniation between 2 and 5 years after surgery. Progressive postoperative spondylolisthesis occurred in 31% of patients with normal preoperative alignment (mean 7.8 mm, range 2-20 mm) and in 73% of patients with preoperative subluxation (mean 5.1 mm, range 2-13 mm) in whom fusion was not attained. Radiological progression did not correlate well with patient-reported outcome. The major conclusions from this study are the following: 1) the majority of patients respond well to this surgery, but complication (22%) and late deterioration (10%) rates are not insignificant; 2) radiological instability is common after decompression for degenerative lumbar spinal stenosis, but this correlates poorly with clinical outcome; 3) there are no definitive clinical or radiological factors that preoperatively predict patients at risk for a poor outcome; 4) post-operative radiological instability is more likely to occur when the following criteria are present: preoperative spondy-degenerated L-4 or a markedly degenerated L-3 disc; and when a radical and extensive decompression greater than one level is planned; and 5) the group at greatest risk for a poor outcome consists of those patients with normal preoperative alignment who do not suffer slippage following surgery.

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

“…Greater comorbidity (p = 0.014) and higher preoperative COMI (p = 0.048) were also significant predictors of a worse outcome in the multivariable model degenerative changes leading to canal compromise. Fox et al looked at a series of patients with decompression for spinal stenosis with and without fusion and reported a progression in spondylolisthesis after decompression alone in 73% of patients with LDS compared with 31% without, again demonstrating the ongoing process of instability that might be enhanced by decompression alone [4]. The findings of the present study concur with those reported by Martin et al in systematically reviewing the literature comparing different types of surgical treatment for LDS [14].…”

Degenerative lumbar stenosis: update

“…However, there are many papers with class II and III evidence levels advocating concomitant spinal fusion and arthrodesis to improve outcomes and avoid late instabilities, even in patients without spondylolisthesis or spinal deformities [29][30][31][32][33][34] . It is known that when more than 30% of the articular facets are removed bilaterally, we have a greater probability of developing late instability, justifying fusion in patients subjected to large decompressive surgeries 35 .…”

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

“…Surgical procedures aim to decompress the nerve root emerging from the thecal sac along its course in the lateral recess. A multitude of surgical procedures for surgical decompression of symptomatic lateral recess stenosis have been described ranging from standard open laminectomies to minimally invasive decompressive techniques (14)(15)(16)(17)(18)(19)(20)(21)(22). In the current study we describe the surgical technique of endoscopic interlaminar lateral recess decompression in a small cohort of patients with unilateral symptomatic lateral recess stenosis with well-defined radiographic criteria.…”