In Degenerative Spondylolisthesis, Unilateral Laminotomy for Bilateral Decompression Leads to Less Reoperations at 5 Years When Compared to Posterior Decompression With Instrumented Fusion

Abstract

Study Design. Multicenter retrospective cohort study. Objective. The aim of this study was to compare reoperation rates at 5-year follow-up of unilateral laminotomy for bilateral decompression (ULBD) versus posterior decompression with instrumented fusion (Fusion) for patients with low-grade degenerative spondylolisthesis (DS) with lumbar spinal stenosis (LSS) in a multicenter database. Summary of Background Data. Controversy exists regarding whether fusion should be used to augment decompression surgery in patients with LSS with DS. For years, the standard has been fusion with standard laminectomy to prevent postoperative instability. However, this strategy is not supported by Level 1 evidence. Instability and reoperations may be reduced or prevented using less invasive decompression techniques. Methods. We identified 164 patients with DS and LSS who underwent ULBD between January 2007 and December 2011 in a multicenter database. These patients were propensity score-matched on age, sex, race, and smoking status with patients who underwent Fusion (n = 437). Each patient required a minimum of 5-year follow-up. The primary outcome was 5-year reoperation. Secondary outcome measures included postoperative complication rates, blood loss during surgery, and length of stay. Logistic regression models were used to estimate the odds ratio of the 5-year reoperation rate between the two surgical groups. Results. The reoperation rate at 5-year follow-up was 10.4% in the ULBD group and 17.2% in the Fusion group. ULBD reoperations were more frequent at the index surgical level; Fusion reoperations were more common at an adjacent level. The two types of operations had similar postoperative complication rates, and both groups tended to have fusion reoperations. Conclusion. For patients with stable DS and LSS, ULBD is a viable, durable option compared to fusion with decreased blood loss and length stay, as well as a lower reoperation rate at 5-year follow-up. Further prospective studies are required to determine the optimal clinical scenario for ULBD in the setting of DS. Level of Evidence: 3

Unilateral Tubular Approach for Bilateral Laminotomy vs Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

“…However, there is a lack of clinical evidence to com rm its safety and e cacy comparing PEID to TLIF. The current study shows that ULBD technique is a viable option for patients with moderate and severe LSS 14 . Absence of muscle dissection with the endoscope and instruments over the lamina and preservation of the soft tissue structures, could alleviate the muscle atrophy and spinal instability 15 .…”

“…PEID was reported to treat several degenerative lumbar disease, such as degenerative scoliosis and spondylolisthesis, lumbar stenosis, and thoracic disc herniations 14,22,23 . Previous reports have already demonstrated that ULBD is a effective and safe approach to treat degenerative spondylolisthesis 10 .Several clinical study focused attentionon the clinical e cacy of ULBD for the treatment of severe lumbar stenosis.…”

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

“…Lumbar spinal stenosis (LSS) with degenerative spondylolisthesis is an important cause of low back pain (1). The optimal treatment for patients of LSS with degenerative spondylolisthesis remains uncertain (2,3). Surgery may be necessary to relieve the symptoms and improve function after failed conservative treatment in patients of LSS with degenerative spondylolisthesis (4,5).…”

“…Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) was firstly described by Foley et al and had been commonly performed to treat LSS with degenerative spondylolisthesis (10)(11)(12). Decompression alone was also used to treat LSS with degenerative spondylolisthesis to preserve the facet joints, paraspinal musculoligamentous structures, mitigate the risk of adjacent segment fusions after instrumented fusion, and to reduce the healthcare cost (2). Minimally invasive unilateral laminotomy bilateral decompression was performed to treat LSS with degenerative spondylolisthesis to minimize the injury to the paraspinal musculoligamentous structures (6).…”

Automatic Lumbar Spinal CT Image Segmentation With a Dual Densely Connected U-Net

“…Precisely identifying the The associate editor coordinating the review of this manuscript and approving it for publication was Cristian A. Linte. vertebral body, spinal canal and dural sac is helpful in diagnosing different types of LSS [2]. Surgeons usually use lumbar spinal CT images to distinguish between degenerative and developmental LSS because CT is better at imaging osseous and calcified tissues than MRI is [3].…”