Clinical Outcomes of Interlaminar Percutaneous Endoscopic Decompression for Degenerative Lumbar Spondylolisthesis with Spinal Stenosis.

Pornpavit Sriphirom,Preewut Chaipanha,Chalit Saepoo,Chaiyaporn Siramanakul

doi:10.3390/brainsci11010083

Clinical Outcomes of Interlaminar Percutaneous Endoscopic Decompression for Degenerative Lumbar Spondylolisthesis with Spinal Stenosis.

Pornpavit Sriphirom, Preewut Chaipanha + Show 2 more

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https://doi.org/10.3390/brainsci11010083

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Abstract

The use of traditional open decompression alone in degenerative spondylolisthesis can lead to the development of postoperative spinal instability, whereas percutaneous endoscopic decompression can preserve the attachment of intervertebral muscles, facet joint capsules, and ligaments that stabilize the spine. The study’s aim was to determine clinical as well as radiologic outcomes associated with interlaminar percutaneous endoscopic decompression in patients with stable degenerative spondylolisthesis. For this study, 28 patients with stable degenerative spondylolisthesis who underwent percutaneous endoscopic decompression were enrolled. The clinical outcomes in terms of the visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated. Radiologic outcomes were determined by measuring the ratio of disc height and the vertebral slippage percentage using lateral standing radiographs. The average follow-up period was 25.24 months. VAS and ODI were significantly improved at the final follow-up. In terms of ratio of disc height and vertebral slippage percentage found no significant difference between the preoperative and postoperative periods. One patient underwent further caudal epidural steroid injection. One patient underwent fusion because their radicular pain did not improve. Interlaminar percutaneous endoscopic decompression is an effective procedure with favorable outcomes in selected patients with stable degenerative spondylolisthesis.

Highlights

Degenerative lumbar spondylolisthesis is described as a vertebra experiences a displacement in the anterior relative to vertebra below it
The process of degenerative spondylolisthesis begins with a phase of facet and disc destruction, leading to translation of the vertebral body on the other side, after that the degenerative changes take place to cause stabilization of the intervertebral level, just as is the cascade of degenerative disc disease introduced by Kirkady–Willis [2,12]
Inose et al found no difference in clinical outcomes in terms of Japanese Orthopedic Association (JOA) scores and visual analogue scale (VAS) between decompression alone, decompression with fusion, or decompression with stabilization in patients with low-grade spondylolisthesis [14]

Summary

Introduction

Degenerative lumbar spondylolisthesis is described as a vertebra experiences a displacement in the anterior relative to vertebra below it. Degenerative lumbar spondylolisthesis often affects levels L3–4 and L4–5 and presents with spinal stenosis or spinal stability. These pathologies can induce back pain, claudication, or radiculopathy. There is an open debate regarding how surgical treatment options between decompression without fusion compare to the combination of decompression and fusion for patients with degenerative lumbar spondylolisthesis without dynamic spinal instability. Traditional open decompression alone can lead to the development of postoperative spinal instability, which adversely effects clinical outcomes compared with fusion [8]. Endoscopic spinal surgery procedure requires a minimal incision and substantially less damage to the soft tissue, as well as protection of facet joints and posterior ligaments, which may result in maintaining stability of the vertebral segment compared with conventional open surgery

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