van Grafhorst Judith M P, Peul Wilco C, Vleggeert-Lankamp Carmen L A
University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands.
University Neurosurgical Center Holland, Leiden University Medical Center, Leiden, The Netherlands.
World Neurosurg. 2025 Jan;193:893-902. doi: 10.1016/j.wneu.2024.10.123. Epub 2024 Nov 22.
One-third of patients with neurogenic claudication caused by lumbar spinal stenosis have low-grade degenerative spondylolisthesis. Decompression in these patients is considered a risk factor for instability, and it remains unclear whether instrumented fusion should be added. This study aims to assess the long-term clinical outcomes of decompressive surgery without instrumented fusion in patients with symptomatic spinal stenosis regardless of low-grade degenerative spondylolisthesis.
In this retrospective cohort study, patients with lumbar spinal stenosis with or without spondylolisthesis undergoing decompressive surgery were studied, 9 years postoperatively. Pain, functionality, and satisfaction questionnaires were sent to 250 patients with spondylolisthesis and 200 randomly selected patients with stenosis. Demographic characteristics, surgical technique, reoperation indication and incidence, and patient-reported outcome measures were assessed.
At long-term follow-up, the mean Oswestry Disability Index was 23.6 ± 20.15 in the spondylolisthesis group and 23.4 ± 20.9 (P = 0.957) in the stenosis group. The EuroQol-5D was 0.74 ± 0.28 and 0.75 ± 0.24 (P = 0.793), respectively. The Zurich Claudication Questionnaire score was 48.2% ± 18.8 and 49.6% ± 18.5 (P = 0.646), respectively. After 9 years of follow-up, comparable satisfaction rates were reported (69% of patients with spondylolisthesis and 68% of patients with stenosis; P = 0.855). Reoperation rates were comparable in the spondylolisthesis and stenosis group (7% vs. 6%).
This cohort study showed comparable satisfaction and clinical outcomes after decompressive surgery for symptomatic spinal stenosis in patients with and without grade 1 degenerative spondylolisthesis. Decompressive surgery can, therefore, be considered an effective treatment for symptomatic lumbar spinal stenosis, even if it is accompanied by degenerative spondylolisthesis. Therefore, routinely adding instrumented spondylodesis is not deemed necessary.
三分之一因腰椎管狭窄导致神经源性间歇性跛行的患者存在低度退行性椎体滑脱。对这些患者进行减压被认为是不稳定的危险因素，是否应加用器械辅助融合仍不明确。本研究旨在评估有症状的椎管狭窄患者，无论是否存在低度退行性椎体滑脱，在未进行器械辅助融合的情况下进行减压手术的长期临床疗效。
在这项回顾性队列研究中，对接受减压手术的有或无椎体滑脱的腰椎管狭窄患者进行术后9年的研究。向250例椎体滑脱患者和200例随机选择的狭窄患者发送疼痛、功能和满意度问卷。评估人口统计学特征、手术技术、再次手术指征及发生率，以及患者报告的结局指标。
在长期随访中，椎体滑脱组的平均Oswestry功能障碍指数为23.6±20.15，狭窄组为23.4±20.9（P = 0.957）。欧洲五维健康量表评分分别为0.74±0.28和0.75±0.24（P = 0.793）。苏黎世间歇性跛行问卷评分分别为48.2%±18.8和49.6%±18.5（P = 0.646）。随访9年后，报告的满意度相当（椎体滑脱患者为69%，狭窄患者为68%；P = 0.855）。椎体滑脱组和狭窄组的再次手术率相当（7%对6%）。
这项队列研究表明，有或无1级退行性椎体滑脱的有症状椎管狭窄患者在减压手术后的满意度和临床疗效相当。因此，减压手术可被视为治疗有症状腰椎管狭窄的有效方法，即使伴有退行性椎体滑脱。因此，常规加用器械辅助脊柱融合术并非必要。
