SURGICAL MANAGEMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS: A COMPARATIVE STUDY OF OUTCOMES FOLLOWING DECOMPRESSION WITH FUSION AND MICROENDOSCOPIC DECOMPRESSION

摘要

Fifty consecutive patients with degenerative lumbar spondylolisthesis were treated surgically. The first 17 patients (FU group) underwent decompression with fusion, the second 33 patients (MED group) underwent microendoscopic decompression (MED), and the outcomes following the two surgical methods were compared. The duration of follow-up ranged from 27 to 40 months in the FU group and from 25 to 40 months in the MED group. Clinical outcomes were evaluated with use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Although statistically not significant, the degrees of improvement in all five functional scores were greater in the MED group than in the FU group. There was no influence of instability before MED to the clinical outcome, and a large percentage of slipping in the neutral position could lead to inadequate improvement in low back pain after MED, but MED is a useful, minimally invasive operation and can lead to a good clinical outcome for degenerative lumbar spondylolisthesis. Considering the lower invasiveness of MED, this procedure is recommended in case of degenerative lumbar spondylolisthesis with less than 20 slipping. Posterior decompression and fusion using pedicular screws is recommended in case of degenerative lumbar spondylolisthesis with over 20 slipping.