Short-term comparison of preoperative and postoperative pain after indirect decompression surgery and direct decompression surgery in patients with degenerative spondylolisthesis

Abstract

The purpose of this study was to compare the short-term clinical outcomes between extreme lateral interbody fusion (XLIF) and minimally invasive surgery (MIS)-transforaminal interbody fusion (TLIF) in patients with degenerative spondylolisthesis with stenosis. One hundred-six patients were enrolled; 44 were treated with MIS-TLIF (direct decompression group; DP), and 62 were treated with XLIF (indirect decompression group; IDP). Perioperative indexes included operation time and intraoperative bleeding. Perioperative indexes preoperative and postoperative numeric rating scale (NRS) scores for low back pain (NRS-BP), leg pain (NRS-LP), and leg numbness (NRS-LN), and the preoperative score on the Japanese version of the painDETECT questionnaire (PDQ-J) were also assessed. The average follow-up period for the collection of NRS scores was 12.6 months. The operation time was significantly shorter in the IDP than in the DP group (109.9 ± 35.4 vs. 153.3 ± 50.9 min; p < 0.001). Intraoperative blood loss was also significantly less in the IDP group than in the DP group (85.4 ± 125.4 vs. 258.3 ± 220.4 mL; p < 0.001). The PDQ-J score and preoperative NRS scores (NRS-BP, NRS-LP, and NRS-LN) did not differ significantly between groups. Less improvement in the NRS-BP (ΔNRS-BP) was observed in the DP group than in the IDP group (p < 0.05). Although pain improved after surgery in both groups, IDP surgery was advantageous in minimizing bleeding and preserving posterior support elements such as the facet joints, lamina, and paraspinal muscles. These findings suggest that this may have contributed to the higher rate of improvement in low back pain compared with DP surgery.

Figure 1

Images of a 54-year-old female patient with L4 spondylolisthesis. (a) Preoperative sagittal MRI image. (b) Postoperative sagittal MRI image. (c) Preoperative axial MRI image at the L4–5 disc level. (d) Postoperative axial MRI image at the L4–5 disc level 12 months after XLIF with PPS fixation (IDP) surgery. Pain improved from preoperative to postoperative measurements: back pain, NRS-BP from 9 to 0; leg pain, NRS-LP from 0.5 to 0; and leg numbness, NRS-LN from 9 to 0. MRI, magnetic resonance imaging; IDP, indirect decompression; NRS, numeric rating scale; NRS-BP, NRS for low back pain; NRS-LP, NRS for leg pain; NRS-LN, NRS for leg numbness.

Figure 2

Graphs showing the preoperative and postoperative NRS scores in the two groups. NRS, numeric rating scale; NRS-BP, NRS for low back pain; NRS-LP, NRS for leg pain; NRS-LN, NRS for leg numbness. n.s., not significant; *p < 0.05, ***p < 0.001 indicates significant differences between groups.

Figure 3

Graphs showing improved NRS scores (DNRS, calculated as preoperative NRS—postoperative NRS) in the two groups. n.s., not significant; *p < 0.05 indicates significant differences between groups. NRS, numeric rating scale; NRS-BP, NRS for low back pain; NRS-LP, NRS for leg pain; NRS-LN, NRS for leg numbness.