Lumbar Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Spondylolisthesis.

Abstract

INTRODUCTION Degenerative spondylolisthesis is an important cause of chronic low-back and radiculopathy in the adult US population. Open decompression with or without fusion is considered the standard for management, yet optimal treatment remains controversial. Full endoscopic spine surgery offers an alternative surgical approach with possible advantages. There is a paucity of data on the use of FESS in degenerative spondylolisthesis. Therefore, we present the clinical and radiographic outcomes of 73 patients with low-grade degenerative spondylolisthesis with severe stenosis, who underwent lumbar endoscopic unilateral laminectomy for bilateral decompression. METHODS Patients with low-grade degenerative spondylolisthesis who underwent a lumbar endoscopic ULBD at six spine centers in North America were included in this study. Patients were followed up at 3, 9, and 12 months. Static and dynamic imaging was performed and evaluated routinely before surgery to identify the pathology and grade of spondylolisthesis. Patient reported outcomes were prospectively collected. RESULTS This study included 73 patients from six spine centers. Sixty-two patients were diagnosed with grade 1 spondylolisthesis while 11 were diagnosed with grade 2 spondylolisthesis. Postoperatively 70 patients reported improved symptoms and pain resolution while three patients reported worse pain. Mean VAS back, VAS leg, and ODI scores showed a statistically significant improvement at 3, 9, and 12-months when compared to the preoperative period. Radiographically, no patient in our study had progression of grade of spondylolisthesis. CONCLUSION Patients with low-grade degenerative spondylolisthesis causing severe stenosis can safely be treated with lumbar endoscopic unilateral laminectomy for bilateral decompression. Head-to-head trial should be undertaken to provide higher level of clinical evidence.