Minim Invasive Neurosurg 2008; 51(5): 267-271
DOI: 10.1055/s-0028-1082314
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Clinical Outcome of Microendoscopic Posterior Decompression for Spinal Stenosis Associated with Degenerative Spondylolisthesis − Minimum 2-year Outcome of 37 Patients

K. Ikuta 1 , O. Tono 2 , M. Oga 2
  • 1Department of Orthopedic Surgery, Karatsu Red Cross Hospital, Karatsu City, Japan
  • 2Department of Orthopedic Surgery, Hiroshima Red Cross and Atomic-bomb Survivors Hospital, Hiroshima, Japan
Further Information

Publication History

Publication Date:
14 October 2008 (online)


A clear consensus for the optimal surgical treatment for spinal stenosis associated with degenerative spondylolisthesis (DS) has not appeared. In general, decompression and fusion are recommended. However, the symptoms of spinal stenosis are the main complaints in almost all patients with DS, and whether or not routine concomitant fusion is necessary in the surgical treatment for DS is still discussed controversially. The authors have treated almost all the patients with spinal stenosis associated with DS by microendoscopic posterior decompression (MEPD) procedures since 2001. In the present study, we examined the minimum 2-year outcome in 37 patients surgically treated with the MEPD procedures for spinal stenosis associated with DS. At the mean of 38 months after surgery, the overall results were excellent in 54% of the patients, good in 19%, fair in 13.5%, and poor in 13.5%, based on the Japanese Orthopedic Association lumbar score, a visual analogue scale, and the Roland-Morris disability questionnaire. Although the progression of spondylolisthesis and the increase of segmental sagittal motion after surgery were seen in 7 patients (19%), only one patient required secondary fusion during the follow-up period. A sufficient decompression with the preservation of the posterior structures of the spine was observed in almost the patients after surgery. In conclusion, the MEPD is a minimally invasive procedure developing a sufficient decompression with the preservation of the spinal stability. Thus, the MEPD is one of the useful procedures in the surgical treatment of spinal stenosis associated with DS. However, further follow-up studies should be performed to evaluate the long-term outcome for evaluation of the true validity of the MEPD for DS.


  • 1 Bassewitz H, Herkowitz H. Lumbar stenosis with spondylolisthesis: Current concepts of surgical treatment.  Clin Orthop. 2001;  384 54-60
  • 2 Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis: A meta-analysis of literture 1970−1993.  Spine. 1994;  19 2256S-2265S
  • 3 Martin CR, Gruszczynski AT, Braunsfurth HA. et al . The surgical management of degenerative spondylolisthesia: A systematic review.  Spine. 2007;  32 1791-1798
  • 4 Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trend and controversies.  Spine. 2005;  30 S71-S81
  • 5 Ikuta K, Arima J, Tanaka T. et al . Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis.  J Neurosurg. 2005;  Spine 2 624-633
  • 6 Nakamura M, Miyamoto K, Shimizu K. Validation of the Japanese version of the Roland-Moriss disability questionnaire for Japanese patients with lumbar spinal disease.  Spine. 2003;  28 2414-2418
  • 7 Takahashi N, Kikuchi S, Fukuhara S. et al . Estimation of Japaneses normative value in age and gender categories of Roland-Morris disability questionnaire.  Rinshoseikeigeka. 2004;  39 315-319 , [in Japanese]
  • 8 Epstein NE. Decompression in the surgical management of degenerative spondylolisthesis; advantages of a conservative approach in 290 patients.  J Spinal Disord. 1998;  11 116-123
  • 9 Herron LD, Trippi AC. L4-5 degenerative spondylolisthesis: The results of treatment by decompressive laminectomy without fusion.  Spine. 1989;  14 534-538
  • 10 Kristof RA, Aliashkevich AF, Schuster M. et al . Degenerative spondylolisthesis induced radicular decompression: non-fusion-related decompression in selected patients without hypermobility on flexion-extension radiographs.  J Neurosurg. 2002;  Spine 3 281-286
  • 11 Booth KC, Bridwell KH, Eisenberg BA. et al . Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion.  Spine. 1999;  24 1721-1727
  • 12 Fischgrund JS, Mackay M, Herkowitz HN. et al . Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation.  Spine. 1997;  22 2807-2812
  • 13 Nork SE, Hu SS, Workman KL. et al . Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondy-lolisthesis.  Spine. 1999;  24 561-569
  • 14 Zdeblick T. A prospective, randomized study of lumbar fusion: Preliminary results.  Spine. 1993;  18 983-991
  • 15 Bridwell KW, Sedgewick TA, O’Brien MF. et al . Role of fusion and instrumentation in the treatment of degenerative spondylolisthesis.  J Spinal Disord. 1993;  6 461-472
  • 16 Ghogawala Z, Benzel EC, Amin-Hanjani S. et al . Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative grade I spondylolisthesis.  J Neurosurg. 2004;  Spine 1 267-272
  • 17 Herkowitz HN, Kurz LT, Michigan RO. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective study comparing decompression with decompression and intertransverse process arthrodesis.  J Bone Joint Surg [Am]. 1991;  73 802-808
  • 18 Lombardi JS, Wiltse LL, Reynolds J. et al . Treatment of degenerative spondylolisthesis.  Spine. 1985;  10 821-827
  • 19 Matsunaga S, Sakou T, Morizono Y. et al . Natural history of degenerative spondylolisthesis: Pathogenesis and natural course of the slippage.  Spine. 1990;  15 1204-1210


K. IkutaMD 

Department of Orthopedic Surgery

Karatsu Red Cross Hospital

1-5-1 Futago

Karatsu City

Saga 847-8588


Phone: +81/955/72 51 11

Fax: +81/955/73 95 30