Microsurgical bilateral decompression via a unilateral approach for lumbar spinal canal stenosis including degenerative spondylolisthesis

Abstract

Object Surgical outcome and radiographic changes after microsurgical bilateral decompression via a unilateral approach (MBDU) for lumbar spinal canal stenosis during midterm follow-up periods (> 2 years) have not been reported. The authors retrospectively investigated surgical outcomes after MBDU in patients with lumbar degenerative spondylolisthesis with stenosis in comparison with patients with degenerative stenosis during a minimum follow-up period of 2 years. Radiographic changes at the affected intervertebral level were analyzed during that follow-up period. Methods Forty-eight patients (23 in the spondylolisthesis group, 25 in the degenerative stenosis group) were included in the study. The average follow-up period was 46 months (range 24–71 months). Surgical outcome was evaluated using the Neurogenic Claudication Outcome Score (NCOS) and the Oswestry Disability Index (ODI). Additionally, the back pain score within the NCOS was also compared. There were no statistically significant differences between the spondylolisthesis group and the degenerative stenosis group with regard to sex, age, follow-up period, operating time, blood loss, surgical sites, approach side, preoperative NCOS, preoperative back pain score, and preoperative ODI. Comparisons were also made between groups using 2 satisfaction measurements at the last follow-up visit. Radiographically, intervertebral angles of 80 sites and slip percentages of 24 sites were measured preoperatively and at the last follow-up. Results No patient in either group had additional surgery in the lumbar spine, including fusion procedures. The NCOS, back pain score, and ODI had significantly improved at the last follow-up in both groups. There were no significant differences between the 2 groups in these 3 parameters and the 2 satisfaction measurements at the last follow-up, although those for the spondylolisthesis group indicated a somewhat worse outcome. Intervertebral angles, dynamic intervertebral angles, and dynamic slip percentage did not significantly change after surgery, whereas only slip percentage significantly increased postoperatively (p = 0.0319). Conclusions A satisfactory outcome of MBDU persisted for a period longer than 2 years for patients with degenerative spondylolisthesis with stenosis as well as for those with degenerative stenosis. Radiographically in both groups this less invasive procedure was not likely to result in postoperative dynamic instability at the affected level, although the slippage progressed in the spondylolisthesis group.