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Ahn, Shin, Lee, Kim, and Choi: A comparison of Decompression and Fusion Surgery in Lumbar Degenerative Spondylolisthesis
Original Article

Journal of Korean Spine Surg 2014;21(4):152-159.

Published online: 21 December 2014

DOI: https://doi.org/10.4184/jkss.2014.21.4.152

A comparison of Decompression and Fusion Surgery in Lumbar Degenerative Spondylolisthesis

Joonghyun Ahn, M.D., Byung-Joon Shin, M.D., Jae Chul Lee, M.D., Seong Min Kim, M.D., Sung-Woo Choi, M.D.

Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea

Corresponding author: Sung-Woo Choi, M.D. Department of Orthopaedic Surgery, Soonchunhyang University Hospital 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-887, Republic of Korea TEL: +82-2-709-9250, FAX: +82-2-794-9414 E-mail: swchoi@schmc.ac.kr

Received 5 December 2014       Revised 7 December 2014       Accepted 8 December 2014

Copyright © 2014 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective, controlled study

Objectives

To assess clinical and radiologic results of decompression without fusion surgery in the treatment of stable lumbar degenerative spondylolisthesis (LDS) and to compare clinical outcomes of fusion surgery.

Summary of Literature Review

Although it is reported that decompression surgery is effective in treating LDS, few reports have compared the outcomes of treatment using decompression and instrumented fusion.

Materials and Methods

A retrospective study was performed and fifty eight degenerative spondylolisthesis patients who received decompression treatment with or without fusion surgery with follow up for at least 2 years were included. The number of patients in the decompression and fusion groups were 23 each and they were selected with age and slip degree taken into account. Clinical factors were evaluated using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) of the back/leg and high risk of operation. Radiological factors were evaluated such as slippage, angulation, and disc height at the affected level in preoperative and final follow up.

Results

There was no statistical difference between the decompression and fusion groups in the VAS of the back/leg, slippage, and high risk of operation preoperatively (p>0.05). The mean operative time was 73.9 minutes in the decompression group and 123.7 minutes in the fusion group. The mean blood loss was 134.5mL in the decompression group and 323.5mL in the fusion group. VAS of the back/leg and ODI improved in both groups and there were no significant differences between the two groups statistically.

Conclusions

Decompression with/without fusion had a favorable clinical outcome in stable degenerative spondylolisthesis patients. However, fusion involves more operative time and blood loss compared to simple decompression. Simple decompression is a good treatment option, especially in operative high risk patients.

Keywords: Lumbar, Degenerative spondylolisthesis, Decompression, Fusion

REFERENCES

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Table 1.
Patients demographics and baseline data (decompression group)
Case No Age Sex F/U (M) *Op method Level Decompression No. Complications
1 81 F 104 1 L4-5 1 no
2 76 M 24 2 L4-5 2 no
3 76 F 52 1 L4-5 4 no
4 73 F 30 1 L4-5 1 no
5 70 M 36 2 L4-5 1 no
6 64 M 36 2 L4-5 1 no
7 61 F 24 2 L4-5 3 no
8 71 M 48 2 L5-6 1 no
9 73 F 43 2 L4-5 1 no
10 73 F 24 2 L4-5 1 no
11 86 M 30 1 L4-5 2 Dura tear
12 64 F 24 2 L4-5 1 no
13 54 F 26 2 L4-5 1 no
14 53 F 26 1 L4-5 2 no
15 71 F 24 2 L3-4 1 no
16 70 F 24 1 L4-5 1 no
17 62 F 52 1 L4-5 1 Dura tear
18 68 F 30 1 L4-5 1 no
19 63 M 24 1 L3-4-5 2 no
20 50 F 93 2 L3-4-5 2 no
21 60 F 24 2 L4-5 2 no
22 66 F 38 2 L2-3 2 no
23 54 M 123 1 L4-5 1 no

*Op method: 1=bilateral fenenstration method, 2= unilateral laminotomy + internal laminoplasty method.

Table 2.
Patients demographics and baseline data (fusion group)
Case No. Age Sex F/U(M) Level Decompression No. *Complications
1 71 M 44 L4-5 2 no
2 51 F 47 L4-5 1 no
3 58 F 45 L3-4 1 N.root injury+Dura tear
4 63 F 39 L4-5 2 no
5 65 F 73 L3-4 2 no
6 65 F 38 L4-5 2 Dura tear
7 54 F 42 L4-5 2 no
8 76 F 24 L4-5 1 no
9 61 M 53 L4-5 1 no
10 70 F 57 L4-5 1 no
11 62 M 51 L4-5 1 no
12 61 F 52 L4-5 1 no
13 70 F 37 L5-6 1 no
14 63 F 44 L3-4 2 Dura tear
15 67 F 42 L4-5 1 Implant dislodge
16 59 F 61 L3-4 2 no
17 79 F 32 L3-5 2 Dura tear
18 62 F 36 L4-5 1 no
19 54 F 52 L4-5 1 no
20 69 F 24 L4-5 1 no
21 72 M 36 L3-4 1 no
22 67 M 60 L4-5 1 no
23 50 F 60 L4-5 1 no

* complication; double count.

Table 3.
Preoperative profile
Decompression (N=23) Fusion (N=23) p-value
Mean age 66.5 63.9 p>0.05
Sex(M/F) 8:15 5:18 p>0.05
Level L2-3 1 0 p>0.05
L3-4 1 5
L4-5 20 18
L5-S1 1 0
Op risk factor(No.) 1.4 1.0 p>0.05
Radiologic factors Slip 5.8±2.4 5.7±1.4 p>0.05
Angular motion 7.8±3.2 5.7±3.4 *p=0.036
Disc height 9.7±1.5 8.6±1.7 *p=0.027
Clinical factors VAS of back 3.9±2.6 4.7±3.2 p>0.05
VAS of leg 7.3±1.8 6.4±2.8 p>0.05
ODI 54.1±6.7 48.1±12.2 *p=0.044

* a significant difference statistically.

Table 4.
Clinical results
Decompression Fusion p-value
Preop. Final I Improvement (%) Preop. Final I Improvement (%)
VAS of back 3.9±2.6 1.6±1.4 59 4.7±3.2 2.3±2.0 51 p>0.05
VAS of leg 7.3±1.8 1.4±2.4 81 6.4±2.8 1.1±2.1 83 p>0.05
ODI 54.1±6.6 22.7±13.9 58 48.1±12.2 18.9±12.4 61 p>0.05
Table 5.
Radiologic results
Decompression Fusion p-value
Preop. Final Preop. Final
Slippage(mm) 5.8±2.4 7.6±2.5 5.7±1.4 1.8±2.0 p=0.00
Angular displacement(°) 7.8±3.2 9.3±3.4 5.7±3.4 3.4±2.6 p=0.00
Disc height(mm) 9.7±1.5 9.0±1.4 8.6±1.7 11.1±1.4 p=0.00
Table 6.
Operation related factors and complications
Decompression Fusion p-value
OP time(min/level) 73.8 128 p=0.000
Bleeding(mL)/level 172.1 335 p=0.003
Complication Dural tear 2 *4
Root injury 0 *1
Implant problem 0 *1
Neurologic Sx. 0 *1
Reoperation 0 *1

∗ , : double count.

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