Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis (original) (raw)
2004, Journal of Neurosurgery: Spine
EGENERATIVE spondylolisthesis with symptomatic spinal stenosis is a common source of low-back pain and radiculopathy. There is considerable debate among spine surgeons regarding whether instrumented pedicle screw fixation and fusion should also be undertaken when a decompressive laminectomy is performed to relieve neural compression. Evaluation of small prospective studies indicates that the addition of fusion may improve outcomes. 2,11 In a 1994 metaanalysis of the literature, 21 the authors found support for the use of fusion. With the dramatic increase in lumbar fusion surgery since 1980, however, many surgeons have criticized the undertaking of fusion in older patients with degenerative spondylolisthesis and spinal stenosis. A less invasive approach might be appropriate in certain patients in whom hypermobility is absent on flexion-extension radiographs. 17 Lumbar fusion for stenosis and spondylolisthesis is associated with higher postoperative mortality, complication, 20 and cost rates. The striking variability in rates of fusion in patients with spinal stenosis and degenerative spondylolisthesis, even among surgeons within single institutions, further underscores the importance of identifying the indications for fusion in patients. To determine the outcomes after surgery for degenerative spondylolisthesis and symptomatic spinal stenosis, we studied patients treated surgically for Grade I spondylolisthesis at two institutions. Preoperative and postoperative outcomes data were prospectively obtained. This study was intended to provide pilot data to lay the foundation Object. There is considerable debate among spine surgeons regarding whether fusion should be used to augment decompressive surgery in patients with symptomatic lumbar spinal stenosis involving Grade I degenerative spondylolisthesis. The authors prospectively evaluated the outcomes of patients treated between 2000 and 2002 at two institutions to determine whether fusion improves functional outcome 1 year after surgery.
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