title: Lumbar Degenerative Spondylolisthesis: Changes in Surgical Indications and Comparison of Instrumented Fusion With Two Surgical Decompression Procedures.
abstract: METHODS
  Single-center retrospective case series.
  
  
  OBJECTIVE
  To compare outcomes of instrumented fusion and two methods of decompression for degenerative spondylolisthesis.
  
  
  BACKGROUND
  There is no consensus on the surgical indications or optimum techniques for lumbar degenerative spondylolisthesis.
  
  
  METHODS
  We analyzed the data of 140 patients treated by fusion (n = 80; mean follow-up, 77.9 months) or decompression (n = 60; mean follow-up, 38.0 months) and examined changes in surgical indications over a 12-year period. We compared the outcomes of instrumented fusion with the outcomes of two decompression techniques, the first employing a unilateral approach for bilateral decompression and the second employing a bilateral approach for contralateral decompression, with contralateral foraminal decompression as needed. Postoperative evaluation was made at the final follow-up visit beginning in 2007 by analyzing patient interviews and neurological examination data. We compared results with the Japanese Orthopedic Association symptom score before surgery and at final follow-up.
  
  
  RESULTS
  Surgical indications for fusion narrowed over time, with fusion used less frequently and decompression used more frequently. Similar decreases in clinical symptoms, including low back pain, were achieved with all methods. In the decompression groups, preoperative slip distance and instability, and postoperative slip progression or development of instability, did not correlate significantly with clinical outcome. Slip progression occurred in 8 of 10 levels in patients with preoperative translation ≥5 mm, but these patients showed no increase in instability, defined as translation ≥ 2 mm, at final follow-up.
  
  
  CONCLUSIONS
  Our findings raise a question about the value of the radiologic criteria for performing fusion used in the late period, namely translation ≥5 mm and/or rotation ≥ 10°. If discogenic pain is excluded, decompression alone may be suitable even for patients with severe low back pain and translation ≥5 mm.
  
  
  METHODS
  4.
authors.affiliation: Department of Neurosurgery, Tominaga Hospital, Naniwa-ku, Osaka-shi, Osaka, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Inui
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakami
authors.forename: Noriaki
authors.initials: N
authors.lastname: Nagao
authors.forename: Kouichi
authors.initials: K
authors.lastname: Miyazaki
authors.forename: Kou
authors.initials: K
authors.lastname: Matsuda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Tominaga
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kitano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hasegawa
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Tominaga
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D017116:Low Back Pain / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D013168:Spondylolisthesis / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome