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KMID : 1150320200160010052
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Journal of Korean Society of Geriatric Neurosurgery
2020 Volume.16 No. 1 p.52 ~ p.57
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Comparison of Clinical Results in Geriatric Patients Between Unilateral Tubular Retractor Guided TLIF Combined with Contralateral Decompression and Open Bilateral Decompression with TLIF in the Patients with Spondylolisthesis Experiencing Bilateral Radicu
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Jeon Woo-Man
Shim Young-Woo
Lee Won-Hee
Kim Sung-Tae
Lee Keun-Soo
Paeng Sung-Hwa
Jung Yung-Kyun
Kim Moo-Seong
Jung Yong-Tae
Pyo Se-Young
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Abstract
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Objective: Unilateral hemilaminectomy with bilateral decompression is more effective at preserving ligament and bony structures and reducing the operative time and volume of blood loss than a total laminectomy. We compared the two surgeries and analyzed their efficacies and postoperative patient prognoses in geriatric patients.
Methods: Between January 2017 and August 2019, 32 patients aged older than 65 years and younger than 83 years who experienced radiating pain in both legs and were diagnosed with spondylolisthesis in L4/5 or L5/S1 underwent surgery. Group A included 17 patients who underwent total laminectomy with transforaminal lumbar interbody fusion (TLIF). Group B consisted of 15 patients who underwent unilateral tubular retractor-guided TLIF and contralateral decompression. We compared the efficacies of the surgeries according to the operation time, the volume of blood loss, and length of hospital stay; compared the clinical outcomes using the visual analog scale (VAS) score; and compared the functional outcomes using the MacNab criteria and 36-item short-form health survey (SF-36). An independent t-test was used to analyze variables between the two groups.
Results: Patients in group B had reduced operation times, volumes of blood loss, and numbers of hospital days than those of patients in group A. The postoperative VAS scores of back pain recovered faster in group B. The VAS scores of pain in each leg improved in both groups, and there were no differences in each group. The MacNab criteria were excellent and good, and the SF-36 scores also improved in both groups (p<0.001). No cases of revision or additional surgery with complications were noted.
Conclusion: In geriatric patients, unilateral tubular retractor-guided TLIF combined with contralateral decompression for spondylolisthesis in patients exhibiting symptoms affecting both legs even while in the supine position is a clinically effective, safe, and time-saving alternative treatment that is comparable to bilateral decompression with TLIF.
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KEYWORD
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Laminectomy, Radiculopathy, Spinal fusion, Spondylolisthesis
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