Comparison of Clinical Outcomes Following Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis With Degenerative Spondylolisthesis

Abstract

Introduction: Both lumbar endoscopic unilateral laminotomy bilateral decompression (LE-ULBD) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have been used to treat one-level lumbar spinal stenosis (LSS) with degenerative spondylolisthesis, while the differences of the clinical outcomes are still uncertain.Methods: Among 60 consecutive patients included, 24 surgeries were performed by LE-ULBD and 36 surgeries were performed by MI-TLIF. Patient demographics, operation characteristics and complications were recorded. Sagittal parameters, including slip percentage (SP) and slip angle (SA) were compared. The visual analog scale (VAS) score, the Oswestry Disability Index (ODI) score, and Macnab criteria were used to evaluate the clinical outcomes. Follow-up examinations were conducted at 3, 6, 12, and 24 months postoperatively.Results: The estimated blood loss, time to ambulation and length of hospitalization of the LE-ULBD group were shorter than the MI-TLIF group. Preoperative and final follow-up SP of the LE-ULBD group was of no significant difference, while final fllow-up SP of the MI-TLIF group was significantly improved compared with preoperative SP. The postoperative mean VAS and ODI scores decreased significantly in both LE-ULBD group and MI-TLIF group. According to the modified Macnab criteria, the outcomes rated as excellent/good rate were 95.8 and 97.2%, respectively, in both LE-ULBD group and MI-TLIF group. Intraoperative complication rate of the LE-ULBD and the MI-TLIF group were 4.2 and 0%, respectively. One case of intraoperative epineurium injury was observed in the LE-ULBD group. Postoperative complication rate of the LE-ULBD and the MI-TLIF group were 0 and 5.6%, respectively. One case with transient urinary retention and one case with pleural effusion were observed in the MI-TLIF group.Conclusion: Both LE-ULBD and MI-TLIF are safe and effective to treat one-level LSS with degenerative spondylolisthesis.

Effectiveness and safety of decompression alone versus decompression plus fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis

“…In our meta-analysis, the results showed that ODI did not differ significantly between the two groups, even in subgroup analyses. Hua et al (14) found that the postoperative mean ODI scores decreased significantly in both lumbar endoscopic unilateral laminotomy bilateral decompression group and minimally invasive transforaminal lumbar interbody fusion group. In contrast to our findings, a previous study demonstrated that the ODI scores of decompression with fusion were 3.5 times that of decompression alone in patients with LSS with/without DS (32).…”

“…A study by Kimura et al (25) showed that no significant differences were found between the two groups in terms of preoperative and postoperative VAS. Hua et al (14) reported that there was no statistical difference in VAS score between the experimental group and the control group (WMD: 0.000, 95% CI: −0.258 to 0.258, P=1.000) (Table 2).…”

“…However, some other studies have demonstrated that there are disadvantages to spinal decompression plus fusion compared with decompression alone for LSS + DS patients, including more blood loss, longer operative time, and prolonged length of stay (LOS) (6,12,13). Hua et al demonstrated that clinical outcomes would not be different among those receiving decompression alone and those undergoing decompression with fusion (14). The differences are probably due to an inconsistent difference in study design, such as search sources, and outcome measurement.…”

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

“…Whether ULBD can be applied in patients with lumbar instability has not been reported, and only a few reports on ULBD for lumbar spondylolisthesis are available ( 17 – 19 ). In a study by Park et al ( 17 ), ULBD achieved satisfactory clinical outcomes for grade I lumbar spondylolisthesis with nerve root symptoms, but foraminal stenosis was a contraindication.…”

“…The incidence of ULBD complications varies among reports. Dural tears are a very common complication, occurring in approximately 6.8%–18% of open surgeries and tubular procedures ( 22 , 33 , 34 ) and 0%–7.2% of endoscopic ULBD procedures ( 11 , 19 , 25 ). The reason for this difference is that clear surgical visualization and careful operation under endoscopy help prevent dural tears in the narrow surgical space where high-speed drills and osteotomes are used.…”