How did a less invasive procedure compare with fusion for grade 1 lumbar spondylolisthesis?

Details

Symptomatic lumbar spondylolisthesis (SPL) has traditionally been treated with interbody fusion (IBF). Endoscopic unilateral laminectomy with bilateral decompression (E-ULBD) has emerged as a less invasive alternative, with growing evidence of effectiveness. The authors aimed to comprehensively compare E-ULBD and IBF outcomes in grade 1 lumbar degenerative SPL.

They retrospectively reviewed data from patients treated with either procedure for symptomatic lumbar SPL by one surgeon during the same period. They analyzed demographics, SPL characteristics, surgical profiles, pain management, patient-reported outcomes, and surgical and medical complications. Surgical complications were classified by location at the treated level or an adjacent level and analyzed separately from cases without complications.

The study included 81 patients: 51 underwent E-ULBD and 30 underwent IBF. Mean follow-up was 43.8 months. E-ULBD had significantly shorter hospitalization, less blood loss and fewer medical complications. Surgical complications at the treated level were comparable: 35.3% with E-ULBD and 16.7% with IBF (p = 0.072). IBF had significantly more adjacent-level complications than E-ULBD (20.0% vs 3.9%, p = 0.046), resulting in worse pain and Oswestry Disability Index scores at final follow-up.

In the E-ULBD group, segmental instability and facet violation greater than 10% were significantly associated with symptomatic SPL progression. The authors concluded that E-ULBD may offer better recovery profiles and less clinical burden from complications than IBF for grade 1 lumbar SPL. Nevertheless, surgical complication rates approached 40% with both procedures, while 60% of uncomplicated cases achieved comparable favorable outcomes. Facet violation greater than 10% was a significant risk factor for symptomatic SPL progression after E-ULBD.