Joaquim Andrei F, Milano Jeronimo B, Ghizoni Enrico, Patel Alpesh A
*Department of Neurology, University of Campinas (UNICAMP), Campinas-SP†Neurological Institute of Curitiba, Curitiba-PR, Brazil‡Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
Clin Spine Surg. 2016 Jun;29(5):191-202. doi: 10.1097/BSD.0000000000000357.
A posterior decompression with an instrumented fusion is one of the most common surgical procedures performed for treating symptomatic spinal stenosis associated with degenerative spondylolisthesis (DS). However, some patients may benefit from a decompression alone, avoiding complications related to instrumentation and fusion.
To identify the characteristics of patients with symptomatic DS who may be successfully treated with an isolated decompression.
A systematic literature review of studies including patients who underwent decompression without instrumentation for treatment of DS.
A systematic review of the Medline database was performed. Retrospective and prospective studies of patients with DS who underwent a decompression were included, as well as studies comparing decompression with instrumented decompression. All the articles were classified according to their level of evidence.
Thirteen studies met all inclusion and exclusion criteria. We identified several characteristics that may be associated with a less favorable outcome after a decompression alone: a facet angle >50 degrees, a disk space of >6.5 mm, presence of low back pain rather than lower extremity symptoms, presence of hypermobility in the listhetic level on dynamic radiographs (>1.25 to 2 mm), and resection of the posterior elements. The majority of the studies comparing decompression alone to decompression and instrumented fusion included in our review suggested similar clinical outcomes with both procedures; however, with long-term follow-up, fusion may provide better outcomes. Decompression with a noninstrumented fusion is also a good alternative to improve symptoms in selected patients, potentially decreasing the risk of reoperation compared with an instrumented fusion.
Satisfactory clinical outcome can be achieved with an isolated decompression in selected patients, avoiding the additional risks and costs of instrumentation and spinal fusion. Noninstrumented fusion is also an interesting alternative to instrumented fusion for well-selected patients to decrease complications related to instrumentation.
后路减压并器械辅助融合术是治疗与退变性腰椎滑脱（DS）相关的症状性椎管狭窄最常用的外科手术之一。然而，一些患者可能仅通过减压就能获益，避免与器械和融合相关的并发症。
确定可能通过单纯减压成功治疗的症状性DS患者的特征。
对包括接受非器械辅助减压治疗DS患者的研究进行系统文献综述。
对Medline数据库进行系统综述。纳入对DS患者进行减压的回顾性和前瞻性研究，以及比较减压与器械辅助减压的研究。所有文章均根据其证据水平进行分类。
13项研究符合所有纳入和排除标准。我们确定了一些可能与单纯减压后预后较差相关的特征：关节突角>50度、椎间盘间隙>6.5mm、存在腰痛而非下肢症状、动力位X线片上滑脱节段存在活动过度（>1.25至2mm）以及后部结构切除。我们综述中大多数比较单纯减压与减压及器械辅助融合的研究表明，两种手术的临床结果相似；然而，长期随访显示，融合可能提供更好的结果。非器械辅助融合减压也是改善部分患者症状的良好选择，与器械辅助融合相比，可能降低再次手术的风险。
对于部分患者，单纯减压可取得满意的临床效果，避免器械和脊柱融合带来的额外风险和费用。对于精心挑选的患者，非器械辅助融合也是器械辅助融合的一个有趣替代方案，可减少与器械相关的并发症。
