Clinical result comparision of simple decompression versus decompression and fusion for lumbar stenosis combined with Ⅰ degree degenerative spondylolisthesis

English Keywords:Lumbar stenosis  Lumbar spondylolisthesis  Degenerative  Decompression  Fusion  Internal fixation

English Abstract:

  【Abstract】 Objectives: To compare the clinical results of simple decompression versus decompression and fusion for lumbar stenosis with Ⅰ degree degenerative spondylolisthesis. Methods: 61 consecutive cases suffering from lumbar stenosis with Ⅰ degree degenerative spondylolisthesis between January 1993 and June 2007 were classified into simple decompression group(group A) and decompression and fusion group(group B). There were 28 cases in group A and 33 cases in group B with no statistic difference with respect to age, gender, course of disease, severity of low back or leg pain, slippage extent or disc height between two groups(P＞0.05). Cases in group A received window laminectomy, while cases in group B received extensive laminoplasty, transpedicular internal fixation and posterolateral fusion or interbody fusion. All cases were followed up for at least 2 years, while 25 cases in group A and 31 cases in group B were followed up for 4 to 12 years(average, 6.8±4.7 years) and 4 to 11 years(average, 6.5±4.1 years) respectively(P＞0.05). JOA scores, VAS scores for low back pain and leg pain, disc height and slippage at two year′s and final follow-up were compared. Results: Group B had more operation time and more intraoperative blood loss(P＜0.05). Complications were noted in 3 cases of group A(including tearing of dura sac in 2 and nerve root impingement in 1) and 6 cases in groups B(including tearing of dura sac in 3, radiculalgia in 1, wound infection in 1, and cognitive disorder in 1). 3 cases in group A received revision surgery of decompression and fusion, including 2 cases due to aggravated low back pain and Ⅱ degree spondylolisthesis respectively 5 and 6 years later, and 1 case due to unalleviated low back pain three years later. No case in group B received revision surgery. Good to excellent rate of JOA score in group A and group B was 89.8% and 90.9% at two year′s follow-up, and 78% and 87.1% at the final follow-up respectively, which showed no intergroup statistic difference(P>0.05). VAS score for low back pain decreased statistically, both at two year′s and final follow-up in each group(P<0.05). In group A, the score at final follow-up increased statistically compared with two year′s counterpart(P<0.05), while in group B, the score remained unchanged(P＞0.05). The score in group B was statistically smaller than that in group A at each follow-up(P<0.05). Postoperative VAS scores for leg pain both at two year′s follow-up and final follow-up were better than preoperative ones in each group(P<0.05), with no significant inter-group difference(P＞0.05). In group A, disc height significantly decreased more at final follow-up, and significant difference existed between two year′s and final follow-up(P＜0.05). Slippage remained unchanged at two year′s follow-up, but final follow-up had lower disc height than two-year′s follow-up(P<0.05). In group B, the disc height remained unchanged(P>0.05), slippage progressed significantly(P<0.05), while the reduction was maintained at final follow-up(P>0.05). Conclusions: Both simple decompression and decompression combined with fusion can alleviate low back pain and leg pain effectively for lumbar stenosis with Ⅰ degree degenerative spondylolisthesis at postoperative early stage; simple decompression is relatively minimal invasive with lower incidence of complication, but for long time, the clinical outcome declines, while the latter one has better long time results.