Our Summary

This research paper is a review and analysis comparing two surgical treatments for degenerative lumbar spondylolisthesis (DLS), a common cause of back pain. The two treatments are laminectomy alone (removal of the back part of a vertebra to relieve pressure on nerves or spinal cord) and laminectomy with fusion (joining two vertebrae together).

The researchers looked at a total of 23 studies involving around 91,000 patients. They found that patients who underwent both laminectomy and fusion had more complications and longer hospital stays than those who only had laminectomy. The surgeries with fusion also took longer to perform.

However, despite these disadvantages, the patients who underwent laminectomy with fusion experienced more improvement in their pain and disability than those who only had laminectomy. This means that the additional fusion surgery, though more complex and risky, might provide better relief from the symptoms of DLS in the long term.

In summary, laminectomy with fusion can offer better post-surgery improvement in pain and disability for DLS patients, but it comes with a longer operation and hospital stay.

FAQs

  1. What are the two surgical treatments for degenerative lumbar spondylolisthesis (DLS) discussed in the research?
  2. How does the outcome of a laminectomy with fusion compare to a laminectomy alone in treating DLS?
  3. What are the potential drawbacks of undergoing a laminectomy with fusion surgery for DLS?

Doctor’s Tip

A helpful tip a doctor might tell a patient about spinal laminectomy is to carefully weigh the potential benefits and risks of undergoing laminectomy alone versus laminectomy with fusion for their specific condition. It is important to have a thorough discussion with your healthcare provider to understand the potential outcomes and make an informed decision about the best treatment option for you.

Suitable For

Patients who are typically recommended spinal laminectomy are those who are suffering from symptoms of DLS, such as back pain, leg pain, and numbness or weakness in the legs. These patients may have tried conservative treatments such as physical therapy, medication, or injections without success. They may also have evidence of spinal instability or nerve compression on imaging studies, such as MRI or CT scans.

Patients who are in good overall health and able to tolerate a more complex surgery, such as fusion, may be candidates for laminectomy with fusion. This procedure is often recommended for patients with significant spinal instability or those who have not achieved adequate relief from symptoms with laminectomy alone.

Ultimately, the decision to recommend laminectomy or laminectomy with fusion will depend on the individual patient’s specific symptoms, imaging findings, overall health, and surgical goals. It is important for patients to discuss their options with their healthcare provider to determine the best treatment approach for their unique situation.

Timeline

Before the surgery:

  1. Patient experiences chronic back pain, leg pain, numbness, and weakness due to degenerative lumbar spondylolisthesis.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to determine the extent of the spinal damage.
  3. After consulting with a spine specialist, the decision is made to undergo surgery to alleviate symptoms.

During the surgery:

  1. Patient is placed under general anesthesia.
  2. Surgeon performs a laminectomy, removing part of the vertebra to relieve pressure on the nerves or spinal cord.
  3. In the case of laminectomy with fusion, the surgeon also joins two vertebrae together using bone grafts and hardware.
  4. Surgery typically lasts several hours.

After the surgery:

  1. Patient is monitored in the recovery room before being transferred to a hospital room.
  2. Patient may experience pain and discomfort at the surgical site.
  3. Physical therapy and rehabilitation are initiated to aid in recovery.
  4. Patient may need to stay in the hospital for a few days to a week, depending on the type of surgery.
  5. Follow-up appointments are scheduled to monitor progress and address any concerns.
  6. Over time, patient experiences improvement in pain, numbness, and weakness as the spine heals and stabilizes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal laminectomy include:

  1. What are the potential risks and complications associated with undergoing a laminectomy alone?
  2. What are the potential risks and complications associated with undergoing a laminectomy with fusion?
  3. How long is the recovery process for each type of surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. What are the expected outcomes in terms of pain relief and improvement in function for each type of surgery?
  6. How will the decision between laminectomy alone and laminectomy with fusion be made for my individual case?
  7. Are there any alternative treatments or therapies that could be considered for my condition?
  8. How experienced is the surgical team in performing both types of procedures?
  9. What is the success rate of each type of surgery for patients with degenerative lumbar spondylolisthesis?
  10. Are there any specific lifestyle modifications or precautions I should take after the surgery to ensure the best possible outcome?

Reference

Authors: Shukla GG, Chilakapati SS, Matur AV, Palmisciano P, Conteh F, Onyewadume L, Duah H, Griffith A, Tao X, Vorster P, Gupta S, Cheng J, Motley B, Adogwa O. Journal: Spine (Phila Pa 1976). 2023 Jun 15;48(12):874-884. doi: 10.1097/BRS.0000000000004673. Epub 2023 Apr 6. PMID: 37026781