Is low back pain a reason for necessity of fusion surgery in lumbar canal stenosis with Lumbar degenerative spondylolisthesis?

<p>The need for fusion surgery in cases of lumbar canal stenosis, especially with degenerative spondylolisthesis, has not been conclusively established. Only minimally invasive endoscopic decompression is performed in our hospital. A common reason for additional fixation surgery is the presence of low back pain associated with degenerative spondylolisthesis. This is because the back pain is not expected to improve with decompression alone, so the degenerative spondylolisthesis itself needs to be treated with fusion surgery.</p><p>Objective: The purpose of this study was to investigate the relationship between low back pain and degenerative spondylolisthesis in patients undergoing lumbar spinal stenosis surgery, and to verify whether decompression surgery alone, without fixation, can improve low back pain.</p><p>Methods: A total of 213 patients with lumbar spinal canal stenosis who underwent endoscopic decompression surgery only in the L4/5 intervertebral space at our hospital were included in the study. 84 patients were classified into the non-degenerative spondylolisthesis group (NDS group) and 129 patients into the degenerative spondylolisthesis group (DS group), when anterior slip of more than 5% of L4 vertebra was defined as degenerative spondylolisthesis. The mean degree of slippage (%) in DS group was 16.8 (5-35), mean % slip: 4.9 (0-14), Meyerding classification 1st degree 84% (109 cases), 2nd degree 16% (20 cases). Study 1: We examined whether the degree of slip and % slip correlated with the preoperative low back pain numerical rating scale (NRS) in all patients. Study 2: The preoperative and postoperative low back pain NRS were examined between the NDS and DS groups. Study 3: The same study as Study 2 was conducted by limiting the number of cases to those with severe back pain with a preoperative low back pain NRS of 7 or higher.</p><p>Results: Study 1: Neither slip degree nor % slip showed any correlation with preoperative low back pain NRS. Study 2: There was no difference in preoperative and postoperative low back pain NRS between the NDS and DS groups. Study 3: The same results were observed in patients with severe low back pain.</p><p>Discussion & Conclusion: There was no difference in the degree of low back pain between the preoperative and postoperative groups, depending on the presence and degree of slippage, and improvement was seen only with decompression surgery. The same was true for patients with severe preoperative back pain. These results suggest that preoperative back pain is not a reason for additional fusion in patients with degenerative spondylolisthesis.</p>