Ten-Year Clinical Outcomes of Endoscope-Assisted Minimally Invasive Surgical Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis and Comparison with Conservative Treatment

Koshi Nambu; Hitoaki Numata; Junya Yoshitani; Kensyo Suzuki; Naoki Takemoto; Hiroaki Kimura; Nobuhiko Komine; Kenichi Goshima; Yu Mikami; Yu Hatsuchi; Takashi Ishikawa; Takashi Higuchi; Norihiro Oku; Kazuki Asai; Sei Morinaga

doi:10.22603/ssrr.2023-0093

Ten-Year Clinical Outcomes of Endoscope-Assisted Minimally Invasive Surgical Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis and Comparison with Conservative Treatment

Spine Surg Relat Res. 2023 Oct 13;8(1):73-82. doi: 10.22603/ssrr.2023-0093. eCollection 2024 Jan 27.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Toyama Prefectural Saiseikai Takaoka Hospital, Takaoka, Japan.
² Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan.
³ Department of Orthopaedic Surgery, Asanogawa General Hospital, Kanazawa, Japan.
⁴ Department of Orthopaedic Surgery, Munehiro Hospital, Kanazawa, Japan.
⁵ Department of Orthopaedic Surgery, Imizu Municipal Hospital, Imizu, Japan.
⁶ Department of Orthopaedic Surgery, Toyama City Hospital, Toyama, Japan.
⁷ Department of Orthopaedic Surgery, Keyaki Clinic, Kanazawa, Japan.
⁸ Department of Orthopaedic Surgery, Japan Red Cross Kanazawa Hospital, Kanazawa, Japan.
⁹ Department of Orthopaedic Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan.
¹⁰ Department of Orthopaedic Surgery, Hokuriku Hospital, Kanazawa, Japan.
¹¹ Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan.

Abstract

Introduction: This study aimed to evaluate the 10-year clinical outcomes of endoscope-assisted, minimally invasive surgical (MIS) decompression for lumbar spinal canal stenosis (LSS) with lumbar degenerative spondylolisthesis (DS) and to compare the radiographic changes in patients who underwent this procedure with those who underwent conservative therapy at 10-year follow-up.

Methods: Between April 2007 and April 2010, 347 consecutive patients with DS and evidence of LSS underwent conservative treatment first from 2 to 4 weeks. The 114 patients who failed conservative treatment were then treated surgically by endoscope-assisted MIS decompression. Of them, 91 patients were followed for more than 10 years (group S), and 146 of the 233 patients treated conservatively were followed for more than 10 years (group C). Clinical outcomes of endoscope-assisted MIS decompression were assessed using the Short Form Health Survey-36 score (SF-36), the Roland Morris Disability Questionnaire (RDQ), and the neurological leg symptoms of the Japanese Orthopaedic Association Score (JOA score). Radiographic changes of the two groups were assessed by %slip, dynamic %slip, range of motion (ROM), and the height of the disc (DH) on plain radiographs.

Results: Significant improvements in clinical outcomes on the SF-36, RDQ, and neurological leg symptoms of the JOA were observed. Radiographic assessment did not show significant differences in the assessed items between the two groups at baseline and after last treatment. Both groups had significantly decreased ROM and DH.

Conclusions: The 10-year clinical outcomes of endoscope-assisted MIS decompression for DS were generally good. Furthermore, on radiographic comparison, the progress of spondylolisthesis after this procedure was virtually the same as in the natural course of the disease at 10-year follow-up.

Keywords: 10-year follow-up; Conservative therapy; Endoscope-assisted minimally invasive surgical decompression; Lumbar degenerative spondylolisthesis.