INTRODUCTION: Traditional management of symptomatic lumbar spondylolisthesis (SPL) often involves spinal interbody fusion (IBF). However, the emergence of endoscopic unilateral laminectomy with bilateral decompression (E-ULBD) offers a less invasive option, increasingly supported by literature for its effectiveness. Nevertheless, a notable oversight in existing studies is the limited scope of examining complications and reoperations, which predominantly concentrates on their incidence rates alone. This study aims to fill this gap by thoroughly evaluating the outcomes and long-term implications of E-ULBD, comparing them against traditional IBF in SPL treatment.
METHODS: Patients treated with E-ULBD or IBF for symptomatic lumbar SPL from single surgeon within the same period were retrospectively reviewed. Demographics, characteristics of the SPL and surgical interventions, hospital stay and relevant total medical expense, blood loss, patient-reported outcome measures, frequency of analgesic and opioid use, number of pain interventions were collected. For thorough analysis of postoperative complications, operation-related ones were identified through MRI scans conducted immediately postoperatively and subsequently when necessary. These complications were classified by location (index or adjacent level) and type (radiographic or symptomatic). Medical complications were retrospectively collected.
RESULTS: A total of 56 patients were included in the study with an average follow-up duration of 38 months: 30 in the E-ULBD group (Endo group) and 26 in the IBF group (Fusion group). Postoperatively, the Endo group exhibited quicker yet ultimately similar improvements in pain and disability scores. Notably, they had significantly shorter hospital stays, less blood loss, and reduced opioid consumption. The Endo group had higher index-level complications (8 cases: aggravated instability, recurrent stenosis, facet synovial cyst, disc herniation, or arachnoiditis) than adjacent-level (2 cases), with 2 reoperations for progressive instability and a synovial cyst. In contrast, the IBF group experienced more adjacent-level complications (7 cases, 1 requiring reoperation) compared to index-level (3 cases: nonunion, fracture, or incomplete decompression).
DISCUSSION: In the treatment of grade 1 lumbar SPL, both E-ULBD and IBF have shown efficacy. Our study indicates that E-ULBD outperforms IBF in several aspects, including perioperative care, short-term outcomes, and medical expenses, while maintaining comparable long-term outcomes. The advantage of endoscopic surgery, particularly in the context of SPL, lies in its potential for natural restabilization and the minimization of unnecessary fusion, whereas patients treated with IBF are at an increased risk of adjacent level degeneration, which often necessitates further fusion extensions. Consequently, our findings substantiate the benefits of endoscopic decompression in both short-term and long-term management of SPL.