OBJECT
Decompression without fusion for degenerative lumbar
stenosis is an effective treatment for both the
pain and disability of neurogenic claudication. Iatrogenic instability following
decompression may require further intervention to stabilize the spine. The authors review the incidence of postsurgical instability following lumbar
decompression, and assess the impact of surgical technique as well as study design on the incidence of instability. METHODS A comprehensive literature search was performed to identify surgical cohorts of patients with degenerative lumbar
stenosis, with and without preexisting
spondylolisthesis, who were treated with
laminectomy or minimally invasive
decompression without fusion. Data on patient characteristics, surgical indications and techniques, clinical and radiographic outcomes, and reoperation rates were collected and analyzed. RESULTS A systematic review of 24 studies involving 2496 patients was performed, assessing both open
laminectomy and minimally invasive bilateral canal enlargement.
Postoperative pain and functional outcomes were similar across the various studies, and postoperative radiographie instability was seen in 5.5% of patients. Instability was seen more frequently in patients with preexisting
spondylolisthesis (12.6%) and in those treated with open
laminectomy (12%). Reoperation for instability was required in 1.8% of all patients, and was higher for patients with preoperative
spondylolisthesis (9.3%) and for those treated with open
laminectomy (4.1%). CONCLUSIONS Instability following lumbar
decompression is a common occurrence. This is particularly true if
decompression alone is selected as a surgical approach in patients with established
spondylolisthesis. This complication may occur less commonly with the use of minimally invasive techniques; however, larger prospective cohort studies are necessary to more thoroughly explore these findings.