Surgical treatment of patients with degenerative grade I lumbar spondylolisthesis combined with spinal stenosis using minimally invasive bilateral decompression

Objective. To analyze clinical and radiological outcomes of minimally invasive bilateral decompression through a unilateral approach in the treatment of patients with degenerative grade I spondylolisthesis combined with lumbar spinal stenosis.

Material and Methods. A total of 28 patients with degenerative grade I lumbar spondylolisthesis combined with spinal stenosis at one or several levels with clinical manifestations of neurogenic intermittent claudication and low back pain were operated on using the method of bilateral microsurgical decompression through a unilateral approach. The minimum follow-up period was 1 year. Clinical outcomes was assessed using VAS, Oswestry and MacNab questionnaires. Central stenosis of the spinal canal was graded according to Shizas classification based on MRI data, and the degree of segment stability according to Hanley and progression of spondylolisthesis in a neutral position were assessed by a functional lumbar spondylograms before surgery and in the long-term period.

Results. The average hospital stay was 3.07 ± 0.26 days. The average duration of the operation was 145.07 ± 44.67 minutes. When assessing pain by VAS questionnaire, a significant decrease in the median value of the intensity of pain was noted: in the leg – from 7.0 [7.0; 8.0] to 1.0 [1.0; 2.0], in the back – from 5.0 [4.0; 5.0] to 1.0 [1.0; 2.0]. The ODI questionnaire showed a decrease in the median indicator of disability from 60.0 [56.0; 64.0] to 15.0 [12.0; 19.0]. Assessment of radiological outcomes showed a slight increase in the parameters of anteroposterior translation (on average +0.42 mm) and segmental rotation (on average +1.03 degrees) of the operated segment during functional tests, and a slight increase in spondylolisthesis (on average by 1.42 %), which in general did not affect clinical outcomes.

Conclusion. Retrospective analysis of minimally invasive bilateral decompression through unilateral approach in patients with degenerative grade I lumbar spondylolisthesis combined with spinal stenosis without segmental instability provided the evidence of significant clinical efficacy of the method with a low risk of iatrogenic segment instability in the late postoperative period.

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