Endoscopic Unilateral Laminectomy for Bilateral Decompression in Degenerative Spondylolisthesis

Introduction: Degenerative spondylolisthesis is an important cause of chronic low-back and radicular pain in the adult US population. Open approaches are considered the gold standard for management, however, endoscopic surgery is gaining increased traction due to lower complication rates, shorter hospital stay, reduced trauma to the surrounding anatomy, and minimized iatrogenic destabilization. Reports of clinical and radiographic outcomes in patients with severe stenosis in the setting of degenerative spondylolisthesis are scarce. To advance the literature on endoscopic spine surgery, the clinical and radiographic outcomes of 73 patients with low-grade degenerative spondylolisthesis with severe stenosis, who underwent endoscopic unilateral laminectomy for bilateral decompression (ULBD), are presented.

Methods: Patients with low grade degenerative spondylolisthesis who underwent an endoscopic ULBD at six spine centers in North America were included in this study. All patients had at least a three month follow up. X-ray, CT, and/or MRI examinations were carried out routinely before surgery to identify the pathology and grade of spondylolisthesis. Patient reported outcomes were collected whenever possible.

Results: This study included 73 patients from six 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 significantly worse pain. Mean VAS bac, VAS leg and ODI scores showed a statistically significant improvement at 3 and 9-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 endoscopic ULBD.