Midterm outcome after a microsurgical unilateral approach for bilateral decompression of lumbar degenerative spondylolisthesis

Clinical article

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Object

The aim of this study was to evaluate the results and effectiveness of bilateral decompression via a unilateral approach in the treatment of lumbar degenerative spondylolisthesis (DS).

Methods

Operations were performed in 84 selected patients (mean age 62.1 ± 10 years) with lumbar DS between the years 2001 and 2008. The selection criteria included lower back pain with or without sciatica, neurogenic claudication that had not improved after at least 6 months of conservative treatment, and a radiological diagnosis of Grade I DS and lumbar stenosis. Decompression was performed at 3 levels in 15.5%, 2 levels in 54.8%, and 1 level in 29.7% of the patients with 1 level of spondylolisthesis. All patients were followed up for at least 24 months. For clinical evaluations, a visual analog scale, Oswestry Disability Index (ODI), and Neurogenic Claudication Outcome Score (NCOS) were used. Spinal canal size and (neutral and dynamic) slip percentages were measured both pre- and postoperatively.

Results

Neutral and dynamic slip percentages did not significantly change after surgery (p = 0.67 and p = 0.63, respectively). Spinal canal size increased from 50.6 ± 5.9 to 102.8 ± 9.5 mm2 (p < 0.001). The ODI decreased significantly in both the early and late follow-up evaluations, and good or excellent results were obtained in 64 cases (80%). The NCOS demonstrated significant improvement in the late follow-up results (p < 0.001). One patient (1.2%) required secondary fusion during the follow-up period.

Conclusions

Postoperative clinical improvement and radiological findings clearly demonstrated that the unilateral approach for treating 1-level and multilevel lumbar spinal stenosis with DS is a safe, effective, and minimally invasive method in terms of reducing the need for stabilization.

Abbreviations used in this paper: DS = degenerative spondylolisthesis; NCOS = Neurogenic Claudication Outcome Score; ODI = Oswestry Disability Index; UMPD = unilateral microsurgical posterior decompression; VAS = visual analog scale.
Article Information

Contributor Notes

Address correspondence to: A. Murat Müslüman, M.D., Avrupa Konutları TEM, B 22 D 50, 34250, Gaziosmanpaşa, Istanbul, Turkey. email: mmusluman@yahoo.com.Please include this information when citing this paper: published online August 26, 2011; DOI: 10.3171/2011.7.SPINE11222.
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