Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis.

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Consensus is lacking on optimal surgical treatment for low-grade degenerative spondylolisthesis, with current trends favoring fusion.
• Existing studies often overgeneralize, neglecting the impact of radiological instability and its variable presentation.
• Understanding the natural history and variable presentations of instability is crucial for treatment decisions.

Purpose of the Study:

• To evaluate the long-term efficacy of decompression-only surgery in patients with low-grade degenerative spondylolisthesis.
• To assess the influence of radiological instability on surgical outcomes.
• To compare decompression-only surgery outcomes against fusion in this patient cohort.

Main Methods:

• Retrospective analysis of patients who underwent decompression-only surgery for degenerative spondylolisthesis between 1990 and 2013.
• Inclusion of clinical and radiological measures of instability.
• Assessment of symptom recurrence, revision surgeries, and functional outcomes (numerical global rate of change scale, visual analogue scale, modified Barthel index) at short-term, mid-term, and long-term follow-up.

Main Results:

• Sixty-four patients were included, with 85.4% experiencing relief from mechanical low back pain postoperatively.
• Radiological instability was identified in a subset of patients using flexion-extension radiographs and prone traction views.
• Reoperation occurred exclusively within the first five years; all functional scores improved significantly by the one-year postoperative mark.

Conclusions:

• Decompression-only surgery demonstrates favorable long-term results for low-grade degenerative spondylolisthesis, even in the presence of instability.
• Further high-level research is warranted to definitively determine the superior surgical approach for patients with radiological instability.