Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability

Ravinsky, Robert; Crawford, Eric J.; Reda, Luke; Rampersaud, Y. Raja

doi:10.1007/s00586-020-06336-4

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…Other authors showed no benefit in adding arthrodesis to decompression in cases of low-grade spondylolisthesis [11][12][13]. Although decompression without fusion may lead to some slip progression, this does not necessarily affect the clinical outcomes, or increase functional disability, as revealed in a report by Ravinsky et al on patients undergoing MIS decompression for LSS with spondylolisthesis [41]. It should be also noted that the addition of arthrodesis to decompression may prolong recovery, increase complications, and increase re-operation rates [2,42,43].…”

Section: Discussionmentioning

confidence: 99%

Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis

et al. 2021

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Background and Objectives: In recent literature, the routine addition of arthrodesis to decompression for lumbar spinal stenosis (LSS) with concomitant stable low-grade degenerative spondylolisthesis remains controversial. The purpose of this study is to compare the clinical outcome, complication and re-operation rates following minimally invasive (MIS) tubular decompression without arthrodesis in patients suffering from LSS with or without concomitant stable low-grade degenerative spondylolisthesis. Materials and Methods: This study is a retrospective review of prospectively collected data. Ninety-six consecutive patients who underwent elective MIS lumbar decompression with a mean follow-up of 27.5 months were included in the study. The spondylolisthesis (S) group comprised 53 patients who suffered from LSS with stable degenerative spondylolisthesis, and the control (N) group included 43 patients suffering from LSS without spondylolisthesis. Outcome measures included complications and revision surgery rates. Pre- and post-operative visual analog scale (VAS) for both back and leg pain was analyzed, and the Oswestry Disability Index (ODI) was used to evaluate functional outcome. Results: The two groups were comparable in most demographic and preoperative variables. VAS for back and leg pain improved significantly following surgery in both groups. Both groups showed significant improvement in their ODI scores, at one and two years postoperatively. The average length of hospital stay was significantly higher in patients with spondylolisthesis (p-value< 0.01). There was no significant difference between the groups in terms of post-operative complications rates or re-operation rates. Conclusions: Our results indicate that MIS tubular decompression may be an effective and safe procedure for patients suffering from LSS, with or without degenerative stable spondylolisthesis.

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Section: Discussionmentioning

confidence: 99%

Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis

et al. 2021

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“…Two surgical methods are commonly used nowadays, namely decompression alone and decompression combined with fusion. It is widely recognized that patients with unstable DLS, especially those with obvious axial pain, will benefit from fusion [ 19 ]. Several studies have shown that there are two criteria for selecting decompression alone in a population of patients with DLS and LSS: (1) mainly characterized by symptoms of radicular pain and neurogenic claudication [ 20 ]; (2) stable DLS (sagittal translation ≤ 3 mm on standing extension-flexion radiographs radiograph or angular displacement ≤ 10°) [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis: a retrospective study

Yu,

Cheng,

Chen

2024

BMC Musculoskelet Disord

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Background Percutaneous transforaminal endoscopic decompression (PTED) is an ideal minimally invasive decompression technique for the treatment of lumbar spinal stenosis (LSS) with degenerative lumbar spondylolisthesis (DLS). The posterosuperior region underneath the slipping vertebral body (PRSVB) formed by DLS is an important factor exacerbating LSS in patients. Therefore, the necessity of removing the PRSVB during ventral decompression remains to be discussed. This study aimed to describe the procedure of PTED combined with the removal of the PRSVB and to evaluate the clinical outcomes. Methods LSS with DLS was diagnosed in 44 consecutive patients at our institution from January 2019 to July 2021, and they underwent PTED combined with the removal of the PRSVB. All patients were followed up for at least 12 months. The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. Results The mean age of the patients was 69.5 ± 7.1 years. The mean preoperative ODI score, VAS score of the low back, and VAS score of the leg were 68.3 ± 10.8, 5.8 ± 1.0, and 7.7 ± 1.1, respectively, which improved to 18.8 ± 5.0, 1.4 ± 0.8, and 1.6 ± 0.7, respectively, at 12 months postoperatively. The proportion of patients presenting “good” and “excellent” ratings according to the modified MacNab criteria was 93.2%. The percent slippage in spondylolisthesis preoperatively (16.0% ± 3.3%) and at the end of follow-up (15.8% ± 3.3%) did not differ significantly (p>0.05). One patient had a dural tear, and one patient had postoperative dysesthesia. Conclusions Increasing the removal of PRSVB during the PTED process may be a beneficial surgical procedure for alleviating clinical symptoms in patients with LSS and DLS. However, long-term follow-up is needed to study clinical effects.

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“…The importance of preservation of midline structures has been emphasized by several studies 2 , 18 , 23 , 30 , 34 , 35 . Minamide et al 18 suggested that the preservation of midline structures enables degenerative spondylolisthesis to continue its natural path to restabilization.…”

Section: Discussionmentioning

confidence: 99%

“…They suggest that 1 in 10 patients treated with decompression only will require fusion in 3 years 36 . Whereas Ravinsky et al 23 argue that the reoperation rate is a poor metric for surgical failure as it is dependent on the interplay of 3 factors: patient willingness to undergo another operation, surgeon willingness to do a revision procedure involving increased complexity and complications, and the healthcare system itself and availability of resources 23 . Although reoperation at the index level may not reflect the actual failure following the index surgery, it is considered an outcome measure of failure in this study since it is a quantifiable proxy that is uniformly reported in the literature to arrive at an estimate.…”

Section: Discussionmentioning

confidence: 99%

Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis

Muthu,

Ćorluka,

Buser

et al. 2024

JBJS Open Access

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Background: Management of lumbar degenerative spondylolisthesis with decompression-only procedure has been performed for its added benefit of a shorter duration of surgery, lower blood loss, and shorter hospital stay. However, reported failure rates for decompression-only procedures vary depending on the methods utilized for decompression. Hence, we aim to identify the failure rates of individual methods of decompression-only procedures performed for degenerative lumbar spondylolisthesis. Methods: An independent systematic review of 4 scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis guidelines. Studies reporting on failure rates defined by reoperation at the index level following decompression-only procedure for degenerative lumbar spondylolisthesis were included for analysis. Studies were appraised using ROBINS tool of Cochrane, and analysis was performed using the Open Meta[Analyst] software. Results: The overall failure rate of decompression-only procedure was 9.1% (95% confidence interval [CI] [6.5-11.7]). Furthermore, open decompression had failure rate of 10.9% (95% CI [6.0-15.8]), while microendoscopic decompression had failure rate of 6.7% (95% CI [2.9-10.6]). The failure rate gradually increased from 6.9% (95% CI [2.0-11.7]) at 1 year to 7% (95% CI [3.6-10.3]), 11.7% (95% CI [4.5-18.9]), and 11.7% (95% CI [6.6-16.7]) at 2, 3, and 5 years, respectively. Single level decompression had a failure rate of 9.6% (95% CI [6.3-12.9]), while multilevel decompression recorded a failure rate of 8.7% (95% CI [5.6-11.7]). Conclusion: High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1% without significant differences between the decompression techniques. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability

Cited by 12 publications

References 22 publications

Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis

Stable Low-Grade Degenerative Spondylolisthesis Does Not Compromise Clinical Outcome of Minimally Invasive Tubular Decompression in Patients with Spinal Stenosis

Percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis: a retrospective study

Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis

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