Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan.
Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, 211-8510, Kawasaki City, Kanagawa, Japan.
BMC Musculoskelet Disord. 2022 Oct 8;23(1):902. doi: 10.1186/s12891-022-05850-4.
Whether lumbar decompression with fusion surgery is effective against Meyerding grade 2 degenerative spondylolisthesis (DS) is unknown. Therefore, the current study aimed to compare the surgical outcomes between posterior decompression alone and posterior decompression with fusion surgery among patients with grade 2 DS with central canal stenosis.
This retrospective cohort study included prospectively registered patients (n = 3863) who underwent surgery for degenerative lumbar spinal canal stenosis at nine high-volume spine centers from April 2017 to July 2019. Patients with grade 2 DS and central canal stenosis were included in the analysis. Patients with radiculopathy, including foraminal stenosis, degenerative scoliosis, and concomitant anterior spinal fusion, and those with a previous history of lumbar surgery were excluded. The participants were divided into the decompression alone group (group D) and decompression with fusion surgery group (group F). Data about patient-reported outcomes, including Numeric Rating Scale (low back pain, leg pain, leg numbness, and foot numbness), Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 2 years postoperatively.
In total, 2354 (61%) patients, including 42 (1.8%) with grade 2 DS (n = 18 in group D and n = 24 in group F), completed the 2-year follow-up. Group D had a higher proportion of female patients than group F. However, the two groups did not significantly differ in terms of other baseline demographic characteristics. Group D had a significantly shorter surgical time and lower volume of intraoperative blood loss than group F. Postoperative patient-reported outcomes did not significantly differ between the two groups, although the preoperative degree of low back pain was higher in group F than in group D. The slip degree of group D did not worsen during the follow-up period.
The surgical outcomes were similar regardless of the addition of fusion surgery among patients with grade 2 DS. Decompression alone was superior to decompression with fusion surgery as it was associated with a lower volume of intraoperative blood loss and shorter surgical time.
对于 Meyerding 分级 2 型退行性脊柱滑脱（DS），腰椎减压融合手术是否有效尚不清楚。因此，本研究旨在比较后路减压单纯手术与后路减压融合手术治疗伴中央椎管狭窄的 2 型 DS 的手术效果。
这是一项回顾性队列研究，纳入了 2017 年 4 月至 2019 年 7 月在 9 个高容量脊柱中心接受退行性腰椎椎管狭窄症手术治疗的前瞻性注册患者（n=3863）。纳入伴中央椎管狭窄的 2 型 DS 患者。排除存在根性病变（包括椎间孔狭窄、退行性脊柱侧凸和伴发前路脊柱融合）、伴发前次腰椎手术史的患者。患者分为单纯减压组（组 D）和减压融合手术组（组 F）。术前和术后 2 年分别记录患者报告的结果（包括数字评分量表[下腰痛、腿痛、腿麻和足麻]、Oswestry 功能障碍指数、欧洲五维健康量表和 12 项简明健康调查评分）。
共有 2354 例（61%）患者完成了 2 年随访，其中 42 例（1.8%）为 2 型 DS（组 D 18 例，组 F 24 例）。组 D 中女性患者比例高于组 F，但两组在其他基线人口统计学特征方面无显著差异。与组 F 相比，组 D 的手术时间更短，术中出血量更少。两组术后患者报告的结果无显著差异，但组 F 的术前腰痛程度高于组 D。组 D 的滑脱程度在随访期间没有恶化。
对于 2 型 DS 患者，是否行融合手术对手术效果无显著影响。单纯减压术优于减压融合术，因为其术中出血量更少，手术时间更短。
