Bilateral decompressive surgery in lumbar spinal stenosis associated with spondylolisthesis: unilateral approach and use of a microscope and tubular retractor system.

Abstract

OBJECT: The objective of this study was to assess the feasibility and efficacy of treating spondylolisthesis-related spinal stenosis via unilateral approach bilateral decompression in which METRx-MD instrumentation is placed. METHODS: Eight consecutive patients with spinal stenosis underwent bilateral decompressions via a unilateral approach in which METRx-MD instrumentation was placed. The procedures were performed on an outpatient basis after induction of general anesthesia. The patients underwent preoperative and 3-month postoperative plain radiography in which flexion-extension x-ray films were obtained. Preoperative and postoperative magnetic resonance imaging was also performed. All radiographs and neuroimages were read by a single radiologist blinded to the clinical results. Eight vertebral levels in the eight patients were surgically decompressed (in one patient an additional level of nonspondylolisthesis-related stenosis was decompressed). The mean operative time was 92 minutes and the mean blood loss was 33 ml/level. Preoperatively stenosis was severe in five patients, moderate/severe in two, and moderate in one; postoperatively stenosis was absent in five, mild in two, and mild/moderate in one. Motion was detected on flexion-extension radiographs in three patients, but on early (3-month) postoperative radiographs there was no evidence of progression. CONCLUSIONS: By following the authors' procedure, minimally invasive bilateral decompression of acquired spinal stenosis associated with spondylolisthesis can be successfully performed on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity.