Highlights
- •We investigated surgical treatments for unstable degenerative spondylolisthesis.
- •Two forms of surgical treatment were compared: (1) Posterior lumbar interbody fusion with cortical bone trajectory (CBT-PLIF); (2) Microendoscopic laminotomy (MEL).
- •Clinical outcomes were similar, but MEL was less invasive.
- •MEL can be an alternative surgical method, as well as CBT-PLIF.
Abstract
Posterior lumbar interbody fusion with cortical bone trajectory (CBT-PLIF) is a form
of minimally invasive decompression and fusion, whereas microendoscopic laminotomy
(MEL) is a form of minimally invasive decompression surgery. No study has compared
the clinical outcomes of the two methods for patients who have degenerative spondylolisthesis
(DS) with instability. In this study, CBT-PLIF and MEL were both offered to 64 patients
who met the inclusion criteria. Each patient then selected his or her preferred treatment.
Twenty patients received CBT-PLIF. They were matched to 30 of the 44 patients receiving
MEL based on age, sex, disease duration, and surgical levels. The 20 patients with
CBT-PLIF formed the CBT group and the 30 matched patients with MEL formed the MEL
group. At 2 years of follow-up, Japanese Orthopaedic Association scores improved to
72.6% and 70.5% in the CBT and MEL groups, respectively. The difference in scores
was not statistically significant. Further, improvements in visual analogue scale
scores for back and leg symptom did not differ significantly between the two groups.
Regarding complications, 1 CBT-group patient (5%) had adjacent-segment degeneration
and 7 MEL-group patients (23%) had same-segment degeneration. Three CBT-group patients
(15%) and 5 MEL-group patients (16%) required reoperation within the follow-up period.
In summary, among patients who had DS with instability, MEL and CBT-PLIF offered comparable
clinical outcomes at 2 years of follow-up. Although the rate of segmental degeneration
was relatively high in the MEL group, both groups had similar reoperation rates.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical NeuroscienceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Surgery for degenerative lumbar spondylosis.Cochrane Database Syst Rev. 2005; : CD001352
- Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.N Engl J Med. 2007; 356: 2257-2270
- Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.N Engl J Med. 2016; 374: 1424-1434
- A randomized, controlled trial of fusion surgery for lumbar spinal stenosis.N Engl J Med. 2016; 374: 1413-1423
- Clinical outcomes of microendoscopic decompressive laminotomy for degenerative lumbar spinal stenosis.Eur Spine J. 2009; 18: 672-678
- Degenerative spondylolisthesis: surgical treatment.Clin Orthop Relat Res. 1976; 112–20
- Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study.Eur Spine J. 2015; 24: 396-403
- Posterior lumbar interbody fusion with cortical bone trajectory screw fixation versus posterior lumbar interbody fusion using traditional pedicle screw fixation for degenerative lumbar spondylolisthesis: a comparative study.J Neurosurg Spine. 2016; 1–5
- Reoperation rate and risk factors of elective spinal surgery for degenerative spondylolisthesis: minimum 5-year follow-up.Spine J. 2015; 15: 1536-1544
- Lumbar fusion for degenerative disease: a systematic review and meta-analysis.Neurosurgery. 2017; 80: 701-715
- Degenerative spondylolisthesis does not affect the outcome of unilateral laminotomy with bilateral decompression in patients with lumbar stenosis.Spine (Phila Pa 1976). 2014; 39: 400-408
- Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis: minimum five-year follow-up.Spine (Phila Pa 1976). 2011; 36: 410-415
- Radiographic evaluation of postoperative bone regrowth after microscopic bilateral decompression via a unilateral approach for degenerative lumbar spondylolisthesis.J Neurosurg Spine. 2013; 18: 472-478
- Cortical bone trajectory for lumbar pedicle screws.Spine J. 2009; 9: 366-373
- Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis.Neurosurgery. 2002; 51: S146-S154
- The influence of preoperative spinal sagittal balance on clinical outcomes after microendoscopic laminotomy in patients with lumbar spinal canal stenosis.J Neurosurg Spine. 2015; 23: 49-54
- Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament.Spine (Phila Pa 1976). 1981; 6: 354-364
- CT evaluation of interbody fusion.Clin Orthop Relat Res. 1985; 47–56
- Biomechanical evaluation of lumbar pedicle screws in spondylolytic vertebrae: comparison of fixation strength between the traditional trajectory and a cortical bone trajectory.J Neurosurg Spine. 2016; 24: 910-915
- Radiological evaluation of the initial fixation between cortical bone trajectory and conventional pedicle screw technique for lumbar degenerative spondylolisthesis.Asian Spine J. 2016; 10: 251-257
- Pars and pedicle fracture and screw loosening associated with cortical bone trajectory: a case series and proposed mechanism through a cadaveric study.Spine J. 2016; 16: e59-e65
- Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis.J Bone Joint Surg Am. 1991; 73: 802-808
- Minimally invasive surgery versus open surgery spinal fusion for spondylolisthesis: a systematic review and meta-analysis.Spine (Phila Pa 1976). 2017; 42: E177-E185
- Morbidity and mortality in the surgical treatment of 10,242 adults with spondylolisthesis.J Neurosurg Spine. 2010; 13: 589-593
- Do lumbar motion preserving devices reduce the risk of adjacent segment pathology compared with fusion surgery? A systematic review.Spine (Phila Pa 1976). 2012; 37: S133-S143
- Risk of adjacent-segment disease requiring surgery after short lumbar fusion: results of the French Spine Surgery Society Series.J Neurosurg Spine. 2016; 25: 46-51
- Which approach is advantageous to preventing development of adjacent segment disease? Comparative analysis of 3 different lumbar interbody fusion techniques (ALIF, LLIF, and PLIF) in L4–5 spondylolisthesis.World Neurosurg. 2017; 105: 612-622
- Minimal access versus open posterior lumbar interbody fusion in the treatment of spondylolisthesis.Neurosurgery. 2010; 66 (discussion): 296-304
- Radiographic natural course of lumbar degenerative spondylolisthesis and its risk factors related to the progression and onset in a 15-year community-based cohort study: the Miyama study.J Orthop Sci. 2015; 20: 978-984
- Clinical outcome of microendoscopic posterior decompression for spinal stenosis associated with degenerative spondylolisthesis–minimum 2-year outcome of 37 patients.Minim Invasive Neurosurg. 2008; 51: 267-271
Article info
Publication history
Published online: August 25, 2018
Accepted:
August 13,
2018
Received:
May 1,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
