title: Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis.
abstract: OBJECTIVE
  The object of this study was to compare minimally invasive surgery (MIS) with open surgery in a severely affected subgroup of degenerative spondylolisthetic patients with severe stenosis (SDS) and high-grade facet osteoarthritis (FJO).
  
  
  METHODS
  From January 2009 to February 2010, 49 patients with severe SDS and high-grade FJO were treated using either MIS or open TLIF. Intraoperative and diagnostic data, including perioperative complications and length of hospital stay (LOS), were collected, using retrospective chart review. Surgical short- and long-term outcomes were assessed according to the Oswestry disability index (ODI) and visual analog scale (VAS) for back and leg pain.
  
  
  RESULTS
  Comparing MIS and open surgery, the MIS group had lesser blood loss, significantly lesser need for transfusion (p = 0.02), more rapid improvement of postoperative back pain in the first 6 weeks of follow-up and a shorter LOS. On the other hand, we experienced in the MIS group a longer operative time. The distribution on the postoperative ODI (p = 0.841), VAS leg (p = 0.943) and back pain (p = 0.735) scores after a mean follow-up of 2 years were similar. The overall proportion of complications showed no significant difference between the groups (29% in the MIS group vs. 28% in the open group, p = 0.999).
  
  
  CONCLUSIONS
  Minimally invasive surgery for severe SDS leads to adequate and safe decompression of lumbar stenosis and results in a faster recovery of symptoms and disability in the early postoperative period.
authors.affiliation: Department of Neurosurgery, Klinikum Offenbach, Akademisches Lehrkrankenhaus der Universität Frankfurt, Starkenburgring 66, 63069 Offenbach, Germany. neurosurgery@t-online.de
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Archavlis
authors.forename: Mario
authors.initials: M
authors.lastname: Carvi y Nievas
mesh_terms: D000368:Aged; D001416:Back Pain / Q000453:epidemiology; D016063:Blood Loss, Surgical; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D061646:Operative Time; D055013:Osteoarthritis, Spine / Q000453:epidemiology / Q000601:surgery*; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013130:Spinal Stenosis / Q000453:epidemiology / Q000601:surgery*; D013168:Spondylolisthesis / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*