University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands.
Department of Neurosurgery, Spaarne Gasthuis, Haarlem/Hoofddorp, Netherlands.
Acta Neurochir (Wien). 2023 Aug;165(8):2145-2151. doi: 10.1007/s00701-023-05667-7. Epub 2023 Jul 6.
Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment.
Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as 'satisfied' or 'unsatisfied' after initial and secondary surgery. The follow-up was 6 to 12 years.
Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation.
Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.
在伴有退行性脊柱滑脱症的症状性脊柱狭窄症患者中，减压后附加器械性脊柱融合术存在争议。由于退变导致的脊柱滑脱症是关节突关节和椎间盘严重退变的指标，这可能表明脊柱不稳定增加。我们旨在确定脊柱狭窄症手术患者中退行性脊柱滑脱症的发生率，并评估单纯减压术而不进行伴行脊柱融合术作为初始治疗的失败率。
评估了 2007 年至 2013 年间所有接受手术治疗的脊柱狭窄症患者的病历。总结了人口统计学特征、术前影像学特征（狭窄程度、存在和滑脱程度）、手术技术、再手术的发生率和适应证，以及再手术的类型。将初始和二次手术后患者的满意度分为“满意”和“不满意”。随访时间为 6 至 12 年。
共纳入 934 例患者，其中 253 例（27%）存在脊柱滑脱症。接受减压术的滑脱症患者中有 17%需要再次手术，而狭窄症患者中有 12%（p=.059）。在滑脱症组中，有 38%的患者需要进行器械性脊柱融合术，而在狭窄症组中，有 10%的患者需要进行该手术。手术后两个月，狭窄症组和滑脱症组的满意度百分比相当（80%对 74%）。在 253 例滑脱症患者中，1%的患者最初接受了器械性脊柱融合术，6%的患者在第二次手术中接受了该手术。
伴有和不伴有（低度）退行性脊柱滑脱症的腰椎狭窄症通常可以通过单纯减压术有效治疗。在第二次手术中进行器械性手术并不会导致对手术结果的满意度降低。
