gms | German Medical Science

Objective: The management of low-grade degenerative lumbar spondylolisthesis remains controversial. There are several surgical treatments including spinal decompression with or without instrumented or non-instrumented fusion and dynamic implants or spacers. The minimally invasive technique should allow an excellent segmental decompression. Furthermore it should protect the posterior stabilizing structures by reducing the iatrogenic traumatization. We present our results after this kind of neurosurgical treatment.

Methods: A study cohort of 80 patients underwent minimally invasive decompression between 2001 and 2005 in our department. A retrospective analysis was performed including clinical, radiological and demografic parameters. Furthermore the clinical results of longtime follow-up regarding pain, walking capacity and neurological symptoms were evaluated by a questionnaire.

Results: After a mean follow-up of 3 years (17–71 months) a significant improvement concerning neurological symptoms was found (p<0,001). 3 of 4 patients showed a significant reduction of pain (73.2%, p<0,001). 2 of 3 patients reported improvements of walking capacity (66.2%, p<0,001). The mean grade of pain-related disability measured by the modified Pain Disability Index was 30 to 40%. 17.5% of the patients had nearly no restriction of daily activities. Complication rate was generally low.

Conclusions: Minimally invasive spinal decompression without fusion represents a comparatively less traumatic and most cost-effective surgical technique providing good to excellent results in the majority of patients. But until now its exact value cannot be finally estimated because of missing longtime, prospective, randomized studies especially in regard to the newer dynamic spacers.