Assessing the Outcomes of Combined Surgical Techniques in Spondylolisthesis: A One Year Retrospective Analysis : Combined Surgical Techniques in Spondylolisthesis: A One-Year Retrospective Analysis

Kamran Ullah; Rizwan Ullah Khattak

doi:10.54393/pjhs.v6i6.2743

Authors

Kamran Ullah Department of Neurosurgery, Muhammad College of Medicine, Peshawar, Pakistan
Rizwan Ullah Khattak Department of Neurosurgery, Rizwan Medical Center, Peshawar, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i6.2743

Keywords:

Clinical Outcomes, Facetectomy, Foraminotomy, Spondylolisthesis

Abstract

Surgical intervention is the treatment of choice in cases of severe pain in spondylolisthesis that doesn't respond to conservative measures. Decompression and fusion surgery is the gold standard surgical procedure for treating lumbar spondylolisthesis with foraminal stenosis, and it can be carried out in a variety of ways. Objectives: To investigate the outcomes of combined surgical techniques, including facetectomy along with foraminotomy, to secure the normal alignment of the lumbar spine in patients with spondylolisthesis. Methods: This retrospective cross-sectional study included the records of fifty-two patients who underwent facetectomy along with foraminotomy for spondylolisthesis from January 2022 to March 2023. Assessment of demographic information, clinical presentations, and outcomes was conducted. Descriptive statistics were analyzed via IBM SPSS software version 26. Results: The Mean age of the participants was 42 ± 15 years. The majority were female, 31(59%), as compared to male. The most frequent level which demonstrated listhesis was L4-L5 23 (45%), followed by L5, S1 18 (34%) and L3, L4 11(21%). In Type 1 listhesis, Full correction was achieved in 100% of cases, while in Type 2 listhesis, 80% of cases achieved correction. Further significant association (p≤0.05) was found among post-surgical outcomes including pain, functional disability and neurological status. Conclusions: It was concluded that facetectomy combined with foraminotomy is associated with improved clinical outcomes in the management of spondylolisthesis, particularly in Type 1 cases. The procedure was linked to pain relief, enhanced functional ability, and improved neurological status. Further longitudinal studies are required to assess long-term efficacy and safety.

References

Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T et al. Decompression with or without fusion in degenerative lumbar spondylolisthesis. New England Journal of Medicine. 2021 Aug; 385(6): 526-38. doi: 10.1056/NEJMoa2100990. DOI: https://doi.org/10.1056/NEJMoa2100990

Koslosky E and Gendelberg D. Classification in brief: The Meyerding classification system of spondylolisthesis. Clinical Orthopaedics and Related Research®. 2020 May; 478(5): 1125-30. doi: 10.1097/CORR.0000000000001153. DOI: https://doi.org/10.1097/CORR.0000000000001153

Frymoyer JW. Degenerative spondylolisthesis: diagnosis and treatment. JAAOS-Journal of the American Academy of Orthopedic Surgeons. 1994 Jan; 2(1): 9-15. doi: 10.5435/00124635-199401000-00002. DOI: https://doi.org/10.5435/00124635-199401000-00002

Jones TR and Rao RD. Adult isthmic spondylolisthesis. Journal of the American Academy of Orthopedic Surgeons. 2009 Oct; 17(10): 609-17. doi: 10.5435/00124635-200910000-00003. DOI: https://doi.org/10.5435/00124635-200910000-00003

Gagnet P, Kern K, Andrews K, Elgafy H, Ebraheim N. Spondylolysis and spondylolisthesis: A review of the literature. Journal of Orthopedics. 2018 Jun; 15(2): 404-7. doi: 10.1016/j.jor.2018.03.008. DOI: https://doi.org/10.1016/j.jor.2018.03.008

Chugh AJ, Alonso F, Moore R, Cox E, Eubanks J. Stable spondylolisthesis: should management change based on presence of facet cysts? Clinical Spine Surgery. 2019 May; 32(4): 170-4. doi: 10.1097/BSD.0000000000000803. DOI: https://doi.org/10.1097/BSD.0000000000000803

Kaneda K, Kazama H, Satoh H, Fujiya M. Follow-up study of medial facetectomies and posterolateral fusion with instrumentation in unstable degenerative spondylolisthesis. Clinical Orthopedics and Related Research®. 1986 Feb; 203: 159-67. doi: 10.1097/00003086-198602000-00019. DOI: https://doi.org/10.1097/00003086-198602000-00019

Bernard F, Mazerand E, Gallet C, Troude L, Fuentes S. History of degenerative spondylolisthesis: From anatomical description to surgical management. Neurochirurgie. 2019 Apr; 65(2-3): 75-82. doi: 10.1016/j.neuchi.2019.03.006. DOI: https://doi.org/10.1016/j.neuchi.2019.03.006

Ahn Y, Park HB, Yoo BR, Jeong TS. Endoscopic lumbar foraminotomy for foraminal stenosis in stable spondylolisthesis. Frontiers in Surgery. 2022 Nov; 9: 1042184. doi: 10.3389/fsurg.2022.1042184. DOI: https://doi.org/10.3389/fsurg.2022.1042184

Kang K, Rodriguez-Olaverri JC, Schwab F, Hashem J, Razi A, Farcy JP. Partial facetectomy for lumbar foraminal stenosis. Advances in Orthopedics. 2014; 2014(1): 534658. doi: 10.1155/2014/534658. DOI: https://doi.org/10.1155/2014/534658

Calek AK, Widmer J, Fasser MR, Farshad M. Lumbar vertebropexy after unilateral total facetectomy. The Spine Journal. 2023 Nov; 23(11): 1730-7. doi: 10.1016/j.spinee.2023.07.005. DOI: https://doi.org/10.1016/j.spinee.2023.07.005

Hagege B, Tubach F, Alfaiate T, Forien M, Dieudé P, Ottaviani S. Increased rate of lumbar spondylolisthesis in rheumatoid arthritis: A case‐control study. European Journal of Clinical Investigation. 2018 Sep; 48(9): e12991. doi: 10.1111/eci.12991. DOI: https://doi.org/10.1111/eci.12991

Rivollier M, Marlier B, Kleiber JC, Eap C, Litre CF. Surgical treatment of high-grade spondylolisthesis: technique and results. Journal of Orthopedics. 2020 Nov; 22: 383-9. doi: 10.1016/j.jor.2020.08.015. DOI: https://doi.org/10.1016/j.jor.2020.08.015

Guan F, Bao R, Zhu L, Guan G, Chi Z, Gu J et al. Risk factors of postoperative low back pain for low-grade degenerative spondylolisthesis: an at least 2-year follow-up retrospective study. World Neurosurgery. 2017 Nov; 107: 789-94. doi: 10.1016/j.wneu.2017.08.109. DOI: https://doi.org/10.1016/j.wneu.2017.08.109

Abd Razak HR, Dhoke P, Tay KS, Yeo W, Yue WM. Single-level minimally invasive transforaminal lumbar interbody fusion provides sustained improvements in clinical and radiological outcomes up to 5 years postoperatively in patients with neurogenic symptoms secondary to spondylolisthesis. Asian Spine Journal. 2017 Apr; 11(2): 204. doi: 10.4184/asj.2017.11.2.204. DOI: https://doi.org/10.4184/asj.2017.11.2.204

Derman PB and Albert TJ. Interbody fusion techniques in the surgical management of degenerative lumbar spondylolisthesis. Current Reviews in Musculoskeletal Medicine. 2017 Dec; 10: 530-8. doi: 10.1007/s12178-017-9443-2. DOI: https://doi.org/10.1007/s12178-017-9443-2

Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J et al. Surgical or nonoperative treatment for lumbar spinal stenosis? a randomized controlled trial. Spine. 2007 Jan; 32(1):1-8. doi: 10.1097/01.brs.0000251014.81875.6d. DOI: https://doi.org/10.1097/01.brs.0000251014.81875.6d

He D, Li ZC, Zhang TY, Cheng XG, Tian W. Prevalence of lumbar spondylolisthesis in middle‐aged people in Beijing community. Orthopedic Surgery. 2021 Feb; 13(1): 202-6. doi: 10.1111/os.12871. DOI: https://doi.org/10.1111/os.12871

Patel T, Watterson C, McKenzie-Brown AM, Spektor B, Egan K, Boorman D. Lumbar spondylolisthesis progression: what is the effect of lumbar medial branch nerve radiofrequency ablation on lumbar spondylolisthesis progression? A single-center, observational study. Journal of Pain Research. 2021 May: 1193-200. doi: 10.2147/JPR.S310238. DOI: https://doi.org/10.2147/JPR.S310238

Beck AW and Simpson AK. High-grade lumbar spondylolisthesis. Neurosurgery Clinics of North America. 2019 Jul; 30(3): 291-8. doi: 10.1016/j.nec.2019.02.002. DOI: https://doi.org/10.1016/j.nec.2019.02.002

Inculet C, Urquhart JC, Rasoulinejad P, Hall H, Fisher C, Attabib N et al. Factors associated with using an interbody fusion device for low-grade lumbar degenerative versus isthmic spondylolisthesis: a retrospective cohort study. Journal of Neurosurgery: Spine. 2021 Jul; 35(3): 299-307. doi: 10.3171/2020.11.SPINE201261. DOI: https://doi.org/10.3171/2020.11.SPINE201261

Bisson EF, Mummaneni PV, Virk MS, Knightly J, Alvi MA, Goyal A et al. Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database. Journal of Neurosurgery: Spine. 2020 May; 33(3): 349-59. doi: 10.3171/2020.3.SPINE191239. DOI: https://doi.org/10.3171/2020.3.SPINE191239

Seo JH, Park G, Ju CI, Kim SW, Lee SM. Radiological analysis of symptomatic complications after bilateral laminotomy for lumbar spinal stenosis. Korean Journal of Spine. 2012 Mar; 9(1): 18. doi: 10.14245/kjs.2012.9.1.18. DOI: https://doi.org/10.14245/kjs.2012.9.1.18