Lumbar Spondylolisthesis : Decompression and Fixation/Fusion

Lumbar degenerative spondylolisthesis (LDS) is a common disease that results in lumbar stenosis. However, a recommendations for treatment, or standardized surgical treatment has not yet been established. LDS treatment involves release of the stenosis, or decompression followed by fixation and fusion. The main decision of procedure selection depends on the presence of lumbar instability, which is mostly associated with lumbar discomfort. However, the choice of the adequate procedure can be diversified when lumbar discomfort is not related to lumbar instability. We examined 51 cases of LDS between August 2006 and Jaly 2009. Decompression alone or a combined fixation/-fusion procedure was selected according to the absence or presence of lumbar discomfort, respectively. Lumbar discomfort was observed in 73.7% of the cases with spinal instability, and lumbar instability was strongly correlated with lumbar discomfort. Decompression procedure was more minimally invasive, and fixation/-fusion one became less invasive. Both decompression and fixation/-fusion groups showed equally improved neurological status, and discomfort, including low back pain, minimized. Neither procedures caused any permanent disability. Two patients (5.8%) in the decompression group showed symptoms that had originated because of worsening of spinal instability. Subsequently, the patients were treated with transforaminal lumbar interbody fusion (TLIF), and good recovery was achieved. In most cases of LDS without lumbar discomforts, LDS can be adequately treated with minimally-invasive decompression alone. However, fixation/-fusion is required in cases of LDS with lumbar discomforts, and in rare cases, fixation/fusion may be subsequently required in cases without lumbar discomfort.