Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion.
The management of grade I lumbar degenerative spondylolisthesis remains controversial. There have been few reports comparing any form of surgery with conservative treatment. As for surgical management, the need for arthrodesis with instrumentation has not been established. A series of 53 patients with single-level spinal stenosis at L4/5 due to grade I degenerative spondylolisthesis entered into a study to compare outcomes of two surgical methods of treatment with those of a control group treated conservatively: group 1, 19 patients treated by decompression laminectomy combined with posterolateral fusion and pedicle screw instrumentation; group 2, 18 patients treated by decompression of the spinal canal using a laminoplasty technique to preserve the integrity of the midline structure; group 3, 16 patients treated conservatively after being recommended that they have surgery. We compared the 2-year results among the three groups. Alleviation of symptoms was noted in groups 1 and 2, whereas the controls (group 3) showed no improvement. There was no significant difference in the degree of clinical improvement between groups 1 and 2. Spondylolisthesis was controlled in group 1, but it did not lead to better clinical results than those achieved in group 2. Our findings indicate that the technique for decompressing the spinal canal with preservation of the posterior elements of its roof can be useful for treating patients with grade I degenerative spondylolisthesis with symptoms of spinal stenosis.
Matsudaira
Ko
K
Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Yamazaki
Takashi
T
Seichi
Atsushi
A
Takeshita
Katsushi
K
Hoshi
Kazuto
K
Kishimoto
Junji
J
Nakamura
Kozo
K
D000368:Aged; D001863:Bone Screws; D016009:Chi-Square Distribution; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000295:instrumentation / Q000379:methods*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000209:etiology / Q000601:surgery*; D013168:Spondylolisthesis / Q000150:complications*; D016896:Treatment Outcome