Spondylolisthesis after multiple bilateral laminectomies and facetectomies for lumbar spondylosis

Shenkin, Henry A.; Hash, Cecil J.

doi:10.3171/jns.1979.50.1.0045

Cited by 106 publications

(46 citation statements)

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“…Numerous studies have implicated degenerative spondylolisthesis as a poor prognostic indicator. [9,26,30,36,42,50,61,65,68,69,73] Several authors have reported less favorable outcomes in women, [9,19,27,34,50,65,68,69] younger patients, [32,64,67,73] and patients undergoing repeated lumbar surgery. [15,28,52,61,72] Patient characteristics that warrant the consideration of arthrodesis (PLIF) in addition to decompression are listed in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…Tile, et al, [67] reported that all of their patients with spondylolisthesis developed progressive slippage postoperatively. Shenkin and Hash [64] followed 59 patients after multiple-level bilateral laminectomies and facetectomies and reported that 15% of patients in whom three or more levels were removed developed progressive spondylolisthesis. Robertson, et al, [58] reported that 58% of 33 patients treated by means of decompressive laminectomy showed postoperative spondylolisthesis of greater than 5% within 1 year of surgery.…”

Section: Pathological Characteristicsmentioning

confidence: 99%

“…[2,3,19,23,27,29,40,45,51,53,54,63,[68][69][70] A more limited interlaminar decompression with medial facetectomy has been advocated for lateral stenosis without a significant central component. [43,45,57,64] Decompressive surgery alone does not address the underlying degenerative process responsible for creating the stenosis and, in some circumstances, may serve to accelerate it. [9,10,26,[28][29][30]32,36,42,51,57,65] The ideal surgical intervention would remove only the bone and ligament needed to free compressed neural elements while preserving spinal stability without contributing to the degenerative process.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Coric

Branch²

1997

FOC

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Lumbar spinal stenosis is often the result of advanced degeneration of motion segments of the lumbar spine. Loss of disc height, facet displacement and hypertrophy, spondylosis, and spondylolisthesis, as well as buckling of the ligamentum flavum and annulus fibrosus, all contribute to impingement on the spinal canal and intervertebral foramen in lumbar stenosis. There is a subgroup of patients with spinal stenosis in whom the spine is unstable preoperatively or becomes destabilized following decompression who would benefit from an initial fusion procedure. Posterior lumbar interbody fusion (PLIF) addresses several aspects of the multifactorial pathophysiology responsible for spinal stenosis and may arrest the degenerative changes at the fused level. Fusion, in particular PLIF, should be considered in complex cases of lumbar spinal stenosis, most notably in patients with postlaminectomy stenosis or stenosis associated with spondylolisthesis.

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Section: Discussionmentioning

confidence: 99%

Section: Pathological Characteristicsmentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

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Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Coric

Branch²

1997

FOC

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“…Laminectomy including removal of spinous process, supraspinous ligament, interspinous ligament, lamina and ligamentum flavum jeopardize the integrity of posterior complex of the spine. However, iatrogenic instability following extensive laminectomy occurs in some patients with degenerative lumbar canal stenosis or in patients who are associated with pre-existing spondylolisthesis 6–9. Long segment fusions have been done by some workers to obviate postoperative instability; however, such operations result in loss of motion of lumbar spine and predisposes the spine for adjacent level degeneration 10–13.…”

Section: Introductionmentioning

confidence: 99%

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Tuli

Kapoor

Jain

et al. 2011

IJOO

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Background:Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability.Materials and Methods:610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33–85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion–extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion–extension movement, lateral bending and rotationsResults:All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5–10 times, with marked relief (70–90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse.Conclusion:Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.

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“…8,18,20,44,53,61 DLSS is currently the most common indication for spinal surgery in patients older than 65 years, 13,19,20,53,56 and several studies have shown better surgical results over more conservative therapies. 2,5,6,10,25,27,38,63 However, open conventional laminectomy has been criticized because of its limited success rate 60 and potential for negative side effects, such as the increased risk of postoperative instability and the subsequent need for secondary fusion surgery; this is again associated with additional risks and costs, 15,23,28,35,36,52 and also persistent postoperative back pain due to prolonged muscle retraction. 1,39,54 As a result of these potential side effects, the development of less invasive techniques was initiated.…”

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confidence: 99%

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

Boogert

Keers²,

Oterdoom

et al. 2015

SPI

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OBJECT The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two popular techniques are rare. To address this shortcoming, this study compares postoperative functional disability, pain, and patient satisfaction among patients with single-level DLSS who underwent bilateral decompression using either a bilateral or unilateral approach. METHODS This retrospective study included patients who underwent operations between November 1, 2009, and October 1, 2011. These patients underwent single-level bilateral decompressive surgery using either the bilateral or unilateral interlaminar approach at one of 5 participating hospitals. Exclusion criteria included previous lumbar surgery, additional disc surgery, and spondylolisthesis requiring fusion surgery. Primary outcome measures included bodily pain (as reported using the visual analog scale [VAS]), the Roland-Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). In addition, reductions in leg and back symptoms and the patient’s general evaluation of the procedure were queried. Finally, patient satisfaction and surgical parameters were evaluated. Questionnaires were sent to each patient’s home, and electronic patient files were used to collect the data. RESULTS One hundred and seventy-five patients returned the questionnaire (74.4% response rate; 68 and 107 patients who underwent the bilateral or unilateral approach, respectively). Mean age at surgery was 68 years (range 34–89 years), and the mean follow-up period was 14.2 months (range 3.3–27.4 years). There were no significant differences in ODI (20.3 vs 22.6 for the bilateral and unilateral approaches, respectively), RMDQ (3.99 vs 4.8, respectively), or pain scores between treatment groups. Back symptoms were reduced in 74.8% (bilateral: 74.6% vs unilateral: 75%; not significant), and leg symptoms in 80.6% of the patients (bilateral: 73.1% vs unilateral: 85.4%; p = 0.048). In total, 72.1% (bilateral) and 80.0% (unilateral) of patients reported good overall treatment results (p = 0.226). Significantly more patients in the unilateral group reported a better overall satisfaction with the procedure (82.1% vs 69.1%; p = 0.047). CONCLUSIONS There were no differences in postoperative functional disability and pain between the surgical techniques. The significant differences in patient satisfaction and reduction in leg symptoms were unrelated to surgical technique. The overall treatment results were satisfactory. Both techniques are safe and effective options for treating patients with single-level DLSS.

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Spondylolisthesis after multiple bilateral laminectomies and facetectomies for lumbar spondylosis

Cited by 106 publications

References 1 publication

Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Posterior lumbar interbody fusion in the treatment of symptomatic spinal stenosis

Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction

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