Patient outcomes after minimally destabilizing lumbar stenosis decompression - The "port-hole" technique

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. Con-comitant 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 2 1/2 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 nore than 15 minutes. Overall clinical results were 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.