Percutaneous ventral decompression for degenerative lumbar spondylolisthesis in medically compromised geriatric patients
Ho-Yeon Lee, Sang-Ho Lee, Song-Woo Shin
Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Aged; decompression, surgical; lumbar vertebrae/ pathology/surgery; spinal stenosis/pathology/surgery; spondylolisthesis/surgery/radiography.
Objectives: The purpose of this study was to present the surgical technique of percutaneous ventral decompression for degenerative lumbar spondylolisthesis (DLS) in medically compromised geriatric patients and to evaluate its results.
Patients and methods: The study included 11 consecutive patients (mean age 67 years; range 51 to 85 years) with DLS accompanied by compressive central canal stenosis and lateral recess stenosis. The affected levels were L3-4 in two patients, and L4-5 in nine patients. All the patients had complaints of bilateral buttock pain, leg pain, and back pain, with significant limitation in ambulation. The mean walking distance before surgery was 150 meters, and the mean preoperative Oswestry Disability Index (ODI) score was 72.2%. Coexisting diseases included diabetes (n=4), cardiac disease (n=5) cerebrovascular accident (n=2), or malignancy (n=2). Percutaneous ventral decompression of the thecal sac was performed under local anesthesia through the posterolateral approach and using endoscopic tools, without violation of the posterior bony structure. The mean follow-up period was 25.1 months (range 11 to 38 months).
Results: The mean operation time was 72 minutes (range 50 to 100 min). The mean ODI score decreased to 27.4% (range 4% to 54%) at the final follow-up. All the patients could walk without any difficulty after surgery. Postoperative CT images demonstrated an enlarged spinal canal in all the patients. The only complication was transient quadriceps weakness in one patient. None of the patients showed progression of spondylolisthesis.
Conclusion: Percutaneous ventral decompression is a safe and effective minimally invasive method for treating DLS in medically compromised geriatric patients, especially when general anesthesia is not recommended.