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Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression – Lumbar Spinal Stenosis

The article explores the debate regarding the addition of instrumented spondylodesis to decompression in patients with symptomatic spinal stenosis and degenerative spondylolisthesis. The study aims to determine the incidence of degenerative spondylolisthesis in surgical candidates for spinal stenosis and evaluate the failure rate of decompressive surgery without concomitant spondylodesis as the initial treatment. Medical files of patients operated on for spinal stenosis between 2007 and 2013 were evaluated, and the demographic and radiological characteristics, surgical techniques, reoperation rates, and patient satisfaction were analyzed. The results show that 27% of patients had spondylolisthesis, and there was a higher reoperation rate in the spondylolisthesis group. However, patient satisfaction was comparable between the groups. The conclusion suggests that decompression alone can effectively treat both spinal stenosis with and without (low-grade) degenerative spondylolisthesis, and instrumented surgery in a second procedure does not negatively impact surgical outcomes

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated spine centre on Harley Street UK

Published article

CONCLUSION: Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.

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Acta Neurochir (Wien). 2023 Jul 6. doi: 10.1007/s00701-023-05667-7. Online ahead of print.ABSTRACTPURPOSE: Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine.,

Acta Neurochir (Wien). 2023 Jul 6. doi: 10.1007/s00701-023-05667-7. Online ahead of print.

ABSTRACT

PURPOSE: Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment.

METHODS: Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as ‘satisfied’ or ‘unsatisfied’ after initial and secondary surgery. The follow-up was 6 to 12 years.

RESULTS: Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation.

CONCLUSION: Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.

PMID:37410183 | DOI:10.1007/s00701-023-05667-7

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Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression

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Acta Neurochir (Wien). 2023 Jul 6. doi: 10.1007/s00701-023-05667-7. Online ahead of print.ABSTRACTPURPOSE: Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine.

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