Abstract
BackgroundLumbar spinal stenosis, often accompanied by degenerative spondylolisthesis, is one of the most common conditions in the elderly. Decompression and fusion is a well-accepted treatment for single-segment lumbar spinal stenosis with degenerative spondylolisthesis; however, the treatment for multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis (MLSS) remains controversial. The objective of this study is to compare the effectiveness of selective decompression and fusion to multi-segmental decompression and fusion for MLSS.MethodsA total of 42 patients suffering from MLSS who underwent surgery between June 2012 and January 2015 were included in this analysis. Of the 42 patients with minimum 3-year follow-up, 22 underwent selective decompression and fusion, and 20 patients underwent multi-segmental decompression and fusion. Age, gender, symptom duration, operative time, blood loss, the number of decompressed segment and fused segment, and complication were compared between the two groups. The visual analog scale (VAS), Oswestry Disability Index (ODI) and Short Form 36 (SF-36) were used to assess efficacy.ResultsOperative time, blood loss, and the number of fused segment in multi-segmental decompression and fusion group were greater than those in selective decompression and fusion group (P < 0.01). The VAS, ODI, and SF-36 scores at 1-year follow-up and 3-year follow-up were significantly improved compared with those preoperatively in both groups (P < 0.01) but were not significantly different between the two groups at each time point (P > 0.05). There was no iatrogenic spinal instability in the decompressed segments in selective decompression and fusion group, while three patients developed postoperative instability at the adjacent segments above the fused segments in multi-segmental decompression and fusion group at 3-year follow-up.ConclusionsSelective decompression and fusion is a safe and effective method for the treatment of MLSS, with the advantages of shorter operative time, less blood loss, and more preservation of spinal motion segments when compared with multi-segmental decompression and fusion.
Highlights
Lumbar spinal stenosis, often accompanied by degenerative spondylolisthesis, is one of the most common conditions in the elderly
Lumbar spinal stenosis is often accompanied by degenerative spondylolisthesis, which commonly occurs in patients more than 50 years [1]
Decompression plus fusion is the well-accepted treatment for patients with single-segment lumbar spinal stenosis with degenerative spondylolisthesis compared with conservative treatment and decompression alone [2, 3]
Summary
Often accompanied by degenerative spondylolisthesis, is one of the most common conditions in the elderly. Decompression and fusion is a well-accepted treatment for single-segment lumbar spinal stenosis with degenerative spondylolisthesis; the treatment for multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis (MLSS) remains controversial. Decompression plus fusion is the well-accepted treatment for patients with single-segment lumbar spinal stenosis with degenerative spondylolisthesis compared with conservative treatment and decompression alone [2, 3]. When it comes to multi-segment lumbar spinal stenosis with single-segment degenerative spondylolisthesis (MLSS), the management remains controversial. In clinical practice, it is sometimes challenging to ensure sufficient spinal stability on the premise of adequate decompression in the non-slipped, stenotic segments, especially in patients with developmental lumbar spinal stenosis combined with foramen stenosis
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