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Br J Neurosurg. 2016 Dec;30(6):662-665. Epub 2016 Jul 20.

Neurogenic claudication secondary to degenerative spondylolisthesis: is fusion always necessary?

Author information

1
a Department of Neurosurgery , The Walton Centre for Neurology and Neurosurgery , Liverpool , UK.
2
b Department of Radiology , The Walton Centre for Neurology and Neurosurgery , Liverpool , UK.

Erratum in

Abstract

OBJECTIVE:

This study examines the efficacy and long-term safety of a midline sparing decompression for patients with degenerative spondylolisthesis (DS). We specifically looked at the rate of re-operation with a lumbar fusion. Of the patients that did require a secondary fusion procedure, we examined retrospectively any risk factors (both clinical and radiological) that could have been identified pre-operatively to predict the necessity of a primary fusion procedure.

MATERIALS AND METHODS:

Data was collected prospectively within a single surgeon practice at our institution. All patients had a diagnosis of neurogenic claudication secondary to DS. Radiological and clinical risk factors that could have predicted the requirement of a fusion procedure were retrospectively analysed.

RESULTS:

This is a study of 70 patients (46F:24M). The median age at surgery was 68 years. All patients had a diagnosis of neurogenic claudication and were treated with a mid-line sparing decompression. Following the primary procedure, patients' VAS and ODI scores for both leg and back pain improved significantly both at short-term follow-up (mean seven months) and sustained at long-term follow-up (range 16-57 months, mean 33 months; p < 0.0001 Wilcoxon matched pair ranks). Eight (11%) patients had symptom progression and required a further fusion procedure. We found that if on the pre-operative MRI, the patient had a facet joint angle of greater than 60°, and a preserved disc height (greater than 7 mm) this would increase the likelihood of the requirement for fusion. Of the patients that required a secondary fusion procedure, 6/8 patients (75%) had sagittal facets, hyperlordosis and a preserved disc height pre-operatively.

CONCLUSIONS:

A primary decompression using a midline sparing osteotomy is an effective procedure for the treatment of neurogenic claudication caused by DS. The second message is that on inspection of the pre-operative imaging, sagittally placed facet joints, a hyperlordosis and a preserved disc height then a fusion procedure should be considered primarily.

KEYWORDS:

Spinous process osteotomy; degenerative spondylolisthesis; lordosis; neurogenic claudication

PMID:
27437763
DOI:
10.1080/02688697.2016.1206181
[Indexed for MEDLINE]

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