Article
Long-term outcome after lumbar spinal canal decompression without fusion in patients with and without spondylolisthesis
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Authors
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Hosai Sadat
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Johannes Hoos
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Richard Bostelmann
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Hans Jakob Steiger
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
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Alexander Sebastian Ahmadi
- Heinrich-Heine-Universität, Universitätsklinikum, Klinik für Neurochirurgie, Düsseldorf, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Lumbar spinal stenosis (LSS) and spondylolisthesis (SL) are common degenerative diseases of the aging spine. The aim of this study was to compare the clinical long-term results between patients with LSS alone and patients with accompanying SL after microsurgical spinal decompression without additional stabilization.
Methods: Retrospective analysis of patients with LSS, who underwent surgical treatment in our hospital between 2003 and 2010. Outcome was measured employing the 12-Item Short Form Health Survey (SF-12), the Oswestry Disability Index (ODI) and a customized questionnaire regarding neurologic deficits. The results were stratified according to presence or absence of SL.
Results: 323 patients underwent microsurgical spinal decompression during the study period. 67 patients (20.7%) had passed away at the time of the survey, 42 (13%) could not be reached, 34 (10.5%) refused to participate. 42 patients underwent fusion surgery and were excluded from this analysis. Thus 138 patients (70 females, 68 males) with complete follow-up (FU) data were included into this study. The mean FU period was 6.6 years. At the time of surgery, the mean age of the cohort was 67.1. 34 patients (24.6%) had SL, of these 29 (85.3%) Meyerding Grade I and 5 (14.7%) Grade II. Back pain was the principal pre-operative complaint (133 patients, 96.4%). Leg pain was reported by 34 patients without SL (32.7%) and 14 patients with SL (41.2%). No statistically significant differences were found regarding the ODI summary and subscore-analyses (Mann-Whitney U) between the two groups: Mean ODI summary score in patients with SL was 62.75, and 71.71 in those without SL (p=0.257). Likewise, differences in SF-12 physical score (with SL 77.29 vs. without SL 66.95; p=0.190) and in SF-12 mental score (with SL 73.94 vs. without SL 68.05; p=0.456) did not reach statistical significance. Differences among groups regarding paresthesia (p=0.216) bladder dysfunction (p=0.426) and colon dysfunction (p=0.109) were not statistically significant.
Conclusion: The clinical long-term outcome after spinal decompression in patients with and without SL showed no statistically significant differences. ODI and SF-12 summary and subscore results were comparable among the two groups. This is consistent with the current studies (Försth et al., NEJM) and emphasizes the limited value of diagnosing SL on x-ray or computed tomography imaging regarding the need for fusion surgery.
