In Degenerative Spondylolisthesis, Unilateral Laminotomy for Bilateral Decompression Leads to Less Reoperations at 5 Years When Compared to Posterior Decompression With Instrumented Fusion: A Propensity-matched Retrospective Analysis

Conclusion. For patients with stable DS and LSS, ULBD is a viable, durable option compared to fusion with decreased blood loss and length stay, as well as a lower reoperation rate at 5-year follow-up. Further prospective studies are required to determine the optimal clinical scenario for ULBD in the setting of DS. Level of Evidence: 3
Source: Spine - Category: Orthopaedics Tags: SURGERY Source Type: research

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Conclusions: The 3D computed tomography technique proved to be a feasible tool in the evaluation of segmental motion in this group of older patients. There was negligible increase in segmental motion after decompressive surgery. LE with removal of the midline structures did not create a greater instability compared with when these structures were preserved.
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Primary Research Source Type: research
CONCLUSIONS: EPD performed under local anesthesia is effective for LSS treatment. Similar favorable outcomes can be obtained in patients with and without preoperative spondylolisthesis using this approach. PMID: 30265225 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research
ConclusionsAlthough the improvement of the first postoperative years decreases over time and despite the lack of general consensus, the lack of established shared guidelines and the limitations of this research, the results support the utilisation of surgery for the management of this condition.Level of Evidence3.
Source: Journal of Orthopaedics and Traumatology - Category: Orthopaedics Source Type: research
J Neurol Surg A Cent Eur Neurosurg DOI: 10.1055/s-0038-1655760 Background Lumbar spinal stenosis (LSS) and low-grade degenerative spondylolisthesis are frequently associated with facet joint degeneration, considered the main cause of low back pain. Surgery is the treatment of choice in patients affected by LSS unresponsive to conservative treatment. The aim of this study was to evaluate the clinical and radiologic outcome of patients treated with posterior decompression and transfacet fixation for single-level LSS and facet joint degeneration. Methods A total of 25 patients between May 2015 and June 2016 af...
Source: Journal of Neurological Surgery Part A: Central European Neurosurgery - Category: Neurosurgery Authors: Tags: Original Article Source Type: research
Authors: Dobran M, Nasi D, Esposito DP, Gladi M, Scerrati M, Iacoangeli M Abstract Study Design: Retrospective study with long-term follow-up. Purpose: To evaluate the long-term incidence of adjacent segment degeneration (ASD) and clinical outcomes in a consecutive series of patients who underwent spinal decompression associated with dynamic or hybrid stabilization with a Flex+TM stabilization system (SpineVision, Antony, France) for lumbar spinal stenosis. Overview of Literature: The incidence of ASD and clinical outcomes following dynamic or hybrid stabilization with the Flex+TM system used for lumbar spi...
Source: Asian Spine Journal - Category: Orthopaedics Tags: Asian Spine J Source Type: research
ConclusionContinuous in vivo dynamic imaging in DS reveals a spectrum of aberrant motion with significantly greater kinematic heterogeneity than previously realized that is not readily seen on current clinical imaging.Level of evidenceLevel V dataGraphical abstract These slides can be retrieved under Electronic Supplementary Material.
Source: European Spine Journal - Category: Orthopaedics Source Type: research
CONCLUSIONS: Microscopic bilateral decompression via a unilateral approach prevents postoperative spinal instability because of satisfactory preservation of facet joints, which may be the primary reason for inadequate bone regrowth. Postoperative bone regrowth was not related to clinical outcomes and postoperative segmental spinal instability. PMID: 28443174 [PubMed]
Source: Asian Spine Journal - Category: Orthopaedics Tags: Asian Spine J Source Type: research
Conclusions: Despite small case series with retrospective design and the absence of a control group, our study suggests that bilateral decompression via a unilateral approach in patients with LSS and grade 1 DS showed good mid-term clinical outcomes, despite an increase in slip percentage. However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray, than in patients without sagittal motion. Therefore, bilateral decompression via a unilateral approach can aggravate symptoms related to instability in patients with preoperative sagittal m...
Source: Journal of Spinal Disorders and Techniques - Category: Surgery Tags: Primary Research Source Type: research
Commentary on: FoĢˆrsth P, Ólafsson G, Carlsson T, et al.. A Randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med 2016;374:1413–23 . Ghogawala Z, Dziura J, Butler WE, et al.. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 2016;374:1424–34. Context The role of fusion in degenerative spondylolisthesis (DS) was hotly debated in the 1990s, until two studies were performed suggesting that patients undergoing fusion in addition to laminectomy had better outcomes and less progression of listhesis than patients undergoing laminectomy...
Source: Evidence-Based Medicine - Category: Internal Medicine Authors: Tags: Clinical trials (epidemiology), Interventional cardiology, Musculoskeletal syndromes Therapeutics/Prevention Source Type: research
Adding spinal fusion to decompression laminectomy did not improve outcomes for patients with lumbar spinal stenosis, even if they also had degenerative spondylolisthesis. Medscape Medical News
Source: Medscape Orthopaedics Headlines - Category: Orthopaedics Tags: Orthopaedics News Source Type: news
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