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Spinous Process Splitting Laminectomy vs Laminectomy and Fusion for Single-Level Lumbar Canal Stenosis With Low-Grade
Ahmad Fouad Abdelbaki Allam1, Wael Koptan2, Alhassan Ibrahim Hassan3
1Orthopaedic Department, Minia University, Minia, Egypt afallam@mu.edu.eg.
Background:
Concomitant spinal canal stenosis and degenerative spondylolisthesis have a wide variation in surgical choices. There is consensus regarding performing fusion for unstable degenerative spondylolisthesis; however, for stable degenerative spondylolisthesis, consensus does not exist. This study aims to compare laminectomy only using spinous process splitting approach and laminectomy and transforaminal lumbar interbody fusion (TLIF) in the treatment of lower lumbar canal stenosis with low-grade stable degenerative spondylolisthesis.
Methods:
Forty-two patients with single-level lumbar canal stenosis and low-grade stable spondylolisthesis were randomly divided into 2 equal groups of 21 patients each. Group I underwent spinous process splitting laminectomy (SPSL), while group II received laminectomy and TLIF. All patients were followed clinically for a minimum of 1 year to assess neurological recovery and radiologically for instability in group I and fusion in group II.
Results:
Postoperatively, both groups showed significant improvements in visual analog scale, Oswestry Disability Index, manual muscle testing, and 6-minute walk distance; these improvements were statistically insignificant except for visual analog scale, where the improvement was greater in group I (P = 0.003). In group I, there was no increase in spondylolisthesis degree or slip percentage at 1 year follow-up. In group II, 18 cases achieved fusion at 6 months, 2 cases achieved fusion at 9 months, and 1 case achieved fusion 1 year follow-up.
Conclusions:
SPSL is effective and safe for stable grade 1 degenerative spondylolisthesis without postlaminectomy instability in short-term follow-up and shows comparable clinical outcomes to laminectomy and TLIF at 1 year. SPSL is more cost-effective than TLIF regarding total hospital cost estimates and early return to activity.
