Patient outcomes after minimally destabilizing lumbar stenosis decompression: the "Port-Hole" technique

Abstract

Study design: A prospective evaluation of the outcome of a decompressive procedure for lumbar spinal stenosis designed to preserve spinal stability.

Objectives: To determine whether decompression could be achieved without subsequent fusion for spinal stenosis with and without degenerative spondylolisthesis.

Summary of background data: The traditional surgical decompression of spinal stenosis involves removal of the posterior elements. Success occurs in 64% of cases, on the average, with results deteriorating over time. Concomitant spinal fusion is associated with higher costs and complication rates.

Methods: This prospective study included 54 consecutive patients treated surgically by one surgeon. Patients were contacted 21/2 and 4 years, on the average, after surgery. Patients with spondylolisthesis were evaluated for worsening of the listhesis after surgery.

Results: At a mean of 4 years after surgery, all patients were satisfied with their treatment. Concerning their symptoms, 80% reported relief of back pain; 96% had improvement of leg pain; 93% experienced relief of leg numbness; and 97% had relief of lower extremity weakness. Before surgery, only 1 patient could walk for longer than 15 minutes. After surgery, 98% (47/48) could walk for more than 15 minutes. Overall clinical results were graded as good to excellent (88%), fair (8%), or poor (4%). Clinical outcomes were comparable between those with and without degenerative spondylolisthesis (P = 0.08). Patients with degenerative spondylolisthesis showed no change in the amount of slip in 13/15 patients (87%).

Conclusions: Degenerative spinal stenosis, even with nonlytic spondylolisthesis, can be decompressed effectively without violating the integrity of the posterior elements.