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PubMed2001

Core decompression with bone grafting for osteonecrosis of the femoral head.

Although core decompression is one of the more popular procedures for treating avascular necrosis, considerable controversy exists concerning its safety and effectiveness. The current authors review the results of a prospective study of 406 hips in 285 patients treated by one surgeon with core decompression and bone grafting. Patients were followed up for 2 to 14 years. The outcome was determined by the change in the Harris hip score, quantitative radiographic measurements, and need for total hip replacement. These hips were compared with 55 hips in 39 patients treated non-operatively and with historic controls. Five complications occurred after 406 procedures including two fractures that resulted from falls during the first postoperative month. Of the 312 hips in 208 patients with a minimum 2-year followup, 36% of hips (113 hips in 90 patients) required hip replacement at a mean of 29 months: 18 of 65 hips (28%) with Stage I disease; 45 of 133 hips (34%) with Stage II disease; three of 13 hips (23%) with Stage III disease; and 45 of 92 hips (49%) with Stage IV disease. Before femoral head collapse (Stages I and II combined) hip replacement was performed in 10 of 77 hips (14%) with small lesions (A), 33 of 68 hips (48%) with intermediate lesions (B), and 20 of 48 hips (42%) with large lesions (C). Results as determined by changes in Harris hip scores and radiographic progression were similar. Patients who underwent core decompression and bone grafting have a very low complication rate. In patients treated before femoral head collapse, the outcome is significantly better than in patients who received symptomatic treatment. The results are correlated with the stage and the size of the necrotic lesion.

Adult↗
PubMed1996

Monitoring of median nerve somatosensory evoked potentials during cervical spinal cord decompression.

We evaluated the intraoperative utility of monitoring median nerve somatosensory evoked potentials (SEPs) in 31 consecutively hospitalized neurosurgical patients (mean age 55.3 +/- 2.1 years) who underwent spinal cord decompression for cervical herniated disc, spondylosis, or tumor. Pre- and postoperative standard neurological examinations included evaluation of motor function, sensory responses, gait, tone, and reflexes. Evoked potentials were recorded from clavicular Erb's (N9) and contralateral cortical (N20) points. Intraoperatively, SEP measurements were obtained after the onset of anesthesia (baseline control) and were repeated throughout the operative procedures. N20 and N9-N20 conduction latencies were measured for each SEP recording; disappearance of the SEP waveform was interpreted as a nonquantifiable increase in latency. Follow-up neurological examinations were made immediately after and up to 6 months following surgery. Postoperatively, the 31 study subjects were assigned to one of two groups based on neurological evaluation: 27 group I subjects had either no change or improvement (good outcome) whereas four group II subjects had postoperative neurological deterioration (poor outcome). Intraoperative N9-N20 interpeak latency was found to increase during cervical decompression in six of 27 group I and in two of four group II subjects. Only two of the Group I subjects exhibited increases > 10% (14 and 19%, respectively). Intraoperative communication to the surgeon of a marked increase of N9-N20 latency during positioning for cervical traction clearly obviated a poor outcome in one group I subject; Upon removal of traction, latency decreased and significant changes in neurological function were not detected postoperatively. The SEP waveform disappeared in two of the group II and in none of the group I subjects. In the two group II subjects exhibiting increases of N9-N20 latencies, increments were > 20%. These findings indicate that in patients undergoing cervical spinal cord decompression, disappearance of SEPs or increases > 20% in the N9-N20 interpeak latency are suggestive of operative conditions that place patients at risk for poor neurological outcome.

Adult↗
PubMed2006

Decompression and lumbopelvic fixation for sacral fracture-dislocations with spino-pelvic dissociation.

PURPOSE: To report results of sacral decompression and lumbopelvic fixation in neurologically impaired patients with highly displaced, comminuted sacral fracture-dislocations resulting in spino-pelvic dissociation. DESIGN: Retrospective clinical study. SETTING: Regional level one trauma center. PATIENTS: Nineteen patients with highly displaced, comminuted, irreducible Roy-Camille type 2-4 sacral fractures with spino-pelvic instability patterns and cauda equina deficits were identified over a 6-year period, 18 of which met the 12-month minimum follow-up criterion. INTERVENTION: All were treated with open reduction, sacral decompression, and lumbopelvic fixation. Radiographic and clinical results were evaluated. Neurological outcome was measured by Gibbons' criteria. MAIN OUTCOME MEASUREMENTS: Radiographic evaluation with computed tomography scan and antero-posterior, lateral, and oblique views of the pelvis to assess alignment, hardware position and decompression. Clinical evaluation emphasizing neurological outcome as described by Gibbons' criteria. RESULTS: Sacral fractures healed in all 18 patients without loss of reduction. Average sacral kyphosis improved from 43 to 21 degrees. Fifteen patients (83%) had full or partial recovery of bowel and bladder deficits, although only 10 patients (56%) had improved Gibbons scores. Average Gibbons score improved from 4 to 2.8 at 31-month average follow-up (range: 12 to 57 mo). Wound infection (16%) was the most common complication. Complete recovery of cauda equina function was more likely in patients with continuity of all sacral roots (86% vs. 0%, P = 0.00037) and incomplete deficits (100% vs. 20%, P = 0.024). Although not statistically significant, recovery of bowel and bladder function specifically was more closely associated with absence of any sacral root discontinuity (86% vs. 36%, P = 0.066) than on completeness of the injury (100% vs. 47%, P = 0.21). CONCLUSIONS: Lumbopelvic fixation provided reliable fracture stability and allowed consistent fracture union without loss of alignment. Neurological outcome was, in part, influenced by completeness of injury and presence of sacral root disruption.

Adolescent↗
PubMed1998

Endoscopic optic nerve decompression: the Graz experience.

Recommendations for management of traumatic injuries to the optic nerve in the literature include expectant management, medical therapy, surgical treatment, and medical therapy combined with surgical decompression. Traditional surgical approaches to optic nerve decompression (OND) are a neurosurgical or craniotomy approach, extranasal transethmoidal approach, transorbital approach, transantral approach, and intranasal microscopic approach. Recent advances in instrumentation and surgical techniques have made an endoscopic approach to OND possible. Since 1991 endonasal endoscopic decompression of the optic nerve has been the surgical approach of choice in patients requiring OND in the authors' hospital. The endoscopic method offers many advantages over the traditional approaches. Decreased morbidity, preservation of olfaction, rapid recovery time, more acceptable cosmetic results with no external scars, no risk of injury to the developing teeth in children, and less operative stress in a patient who may have multisystem trauma are only some of the benefits associated with the endoscopic OND. The authors' technique of endonasal endoscopic approach to OND, medical management, and indications for surgery and the results in 22 patients undergoing this procedure are discussed.

Adolescent↗
PubMed2003

Delayed optic nerve decompression for indirect optic nerve injury.

OBJECTIVE: To test the efficacy of delayed optic nerve decompression in traumatic optic nerve injury. STUDY DESIGN: Critical analysis of Proforma-based, prospectively accrued data of all cases with injury to surgery interval of greater than 2 weeks. METHODS: Thirty-five cases with a median injury to surgery interval of 56 days (range, 16-374 d). Surgical decompression was undertaken only in cases that continued to have poor vision after treatment with steroids in conventional doses (1 mg/kg prednisolone). Pre- and postoperative visual acuity measurements were converted to the logMAR scale of visual acuity and the percentage of visual improvement was calculated. RESULTS: Surgery was universally unrewarding in all 9 cases with persistent and complete blindness of greater than 2 weeks and no response to steroid therapy. Of the cases with some residual vision, 20 of 26 cases improved (mean percentage improvement, 41.0 +/- 5.7%). Cases were categorized on the basis of the injury to surgery interval into groups of 2 weeks to 2 months, 2 months to 4 months, and greater than 4 months. No significant difference was demonstrated in the probability or quantum of improvement in these groups (P =.97). CONCLUSIONS: Optic nerve decompression remains useful as a salvage procedure for conventional dose steroid failed cases of traumatic optic neuropathy. In cases that are not completely blind, vision can be improved even when surgery is undertaken a few months after the injury.

Adolescent↗
PubMed2003

Medial and lateral orbital wall surgery for balanced decompression in thyroid eye disease.

OBJECTIVES/HYPOTHESIS: Diplopia remains a major potential complication of orbital decompression performed for thyroid eye disease. We sought to examine the effect of medial and lateral wall surgery with sparing of the orbital floor on the incidence of postoperative diplopia. STUDY DESIGN: Retrospective review. METHODS: A retrospective review was made of 63 consecutive medial and lateral orbital wall surgeries (40 patients) performed between December 1996 and May 2002 for orbital decompression of thyroid eye disease. RESULTS: The average patient age was 50.9 years of age (age range, 14-83 y). The studied group was predominantly female (sex ratio, 36:4). Indications were compressive optic neuropathy (34), exposure keratopathy (25), and aesthetic concerns (4). The mean time since surgery was 31.5 months (range, 3-69 mo). The medial wall was approached by a transcaruncular (59) or endoscopic (4) technique. Two patients had fat removal. The average improvement in exophthalmos was 4.1 mm (range, 0-10 mm). The average palpebral fissure improvement was 2.0 mm (range, 0-7 mm). Two patients had cerebrospinal fluid leaks during excavation of the sphenoid bone. These were diagnosed and repaired primarily without complication. New-onset diplopia occurred in four patients. Two of these patients required strabismus surgery. CONCLUSION: A 10% new-onset diplopia rate compares favorably with other surgical series. Medial and lateral wall surgery only, sparing the floor, may reduce diplopia after surgery for orbital decompression in thyroid eye disease.

Adolescent↗
PubMed1996

Outcome of surgical decompression of the second cervical root for cervicogenic headache.

OBJECTIVE: There is limited information on the surgical treatment of cervicogenic headache (CH). The objective of this study is to analyze the utility of microsurgical decompression of the second cervical (C2) root and ganglion as a treatment for CH. METHODS: Thirty-nine sequential C2 root and ganglion decompressions, performed for the treatment of CH on 35 patients at the Dartmouth-Hitchcock Medical Center during a 70-month period, were analyzed retrospectively. Preoperative factors and intraoperative findings were evaluated with respect to outcome. RESULTS: At a mean follow-up of 21 months, 12 patients (13 sides) were pain free, and 15 were adequately improved (18 sides). Treatment eventually failed in eight patients. No patient, however, was worse after surgical intervention. There was no major morbidity or mortality associated with the operation. The eight patients with unsatisfactory outcome were evaluated for a possible second operation, and four underwent it. One patient of the four is pain free after 28 months, and two gained adequate improvement at 3 and 12 months. The fourth patient required a third operation but has achieved adequate relief at 6 months. Thus, the overall success rate (either pain free or with adequate improvement) was 90%. No specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. CONCLUSION: The results suggest that microsurgical decompression of the C2 root and ganglion has some utility in treating CH. The accepted diagnostic criteria and success of anesthetic blockade of C2 should identify the subset of patients with CH predominantly caused by C2 root or ganglion effect at this level, which may favor surgical treatment.

Adult↗
PubMed1997

Trigeminal numbness and tic relief after microvascular decompression for typical trigeminal neuralgia.

OBJECTIVE: After most operative treatments for trigeminal neuralgia, long-term tic relief is closely correlated with postoperative numbness in the trigeminal distribution. Microvascular decompression (MVD) is proposed to relieve tic through a nontraumatic mechanism. We investigated the relationship between postoperative trigeminal numbness and tic relief in a large, prospectively followed cohort of patients treated with MVD for typical trigeminal neuralgia. METHODS: Of 1204 patients who underwent MVD for typical tic during a 20-year period, 522 had single MVDs on a single side, had not undergone ablative trigeminal procedures before or after MVD, and were still being followed in 1994. In 1994, patients graded facial numbness using a questionnaire (response rate, 92%) with a 5-point scale. Multivariate Cox and logistic regression methods were used. The analyses were adjusted for the time that had passed between the performance of MVD and the completion of the questionnaire (minimum, 2 yr). RESULTS: Seventeen percent of patients reported some degree of persistent facial numbness. Decompression of a vein at MVD (odds ratio, 2.5) and failure to find compression by the superior cerebellar artery (odds ratio, 2.0) independently predicted postoperative facial numbness, which in turn predicted postoperative burning and aching facial pain (odds ratio, 5.2-5.9). A trend toward worse outcome was noted in patients with numb faces (P = 0.3). Similar findings were noted in subgroups of patients in whom the superior cerebellar artery was decompressed at MVD (n = 381) and in whom a superior cerebellar artery with no vein was found (n = 120). In the latter subgroup, facial numbness (5.8% of patients) significantly predicted worse long-term outcome (P = 0.03). CONCLUSION: We found no evidence that postoperative trigeminal numbness predicts relief of typical tic after MVD. Trigeminal numbness was related to operative findings at MVD and predicted postoperative burning and aching facial pain. To minimize postoperative facial dysesthesia, trauma to the trigeminal root during MVD should be avoided when possible.

Decompression, Surgical↗
PubMed1998

Microvascular decompression of the left lateral medulla oblongata for severe refractory neurogenic hypertension.

OBJECTIVE: To demonstrate that microvascular decompression of the left medulla oblongata is a safe and effective modality for treating elevated blood pressure in patients with severe medically refractory "essential" hypertension (HTN). METHODS: Twelve patients with medically intractable HTN with or without autonomic dysreflexia underwent microvascular decompression of the left rostral ventrolateral medulla oblongata. Causes such as pheochromocytoma, carcinoid syndrome, and renal disease were ruled out before surgery. Indications for surgery included systolic blood pressures greater than 180 mm Hg refractory to three or more medications, severe blood pressure lability, or medically resistant HTN at systolic pressures greater than 160 mm Hg associated with autonomic dysreflexia and/or magnetic resonance images demonstrating left medullary compression. The median age and follow-up duration were 51 years and 4.1 years, respectively. RESULTS: Ten of 12 patients experienced reductions in systolic blood pressure greater than 20 mm Hg. Of these 10 patients, pressure reductions were temporary (6 mo) in two. Seven of eight patients experienced improvement in blood pressure lability and/or autonomic dysreflexia, with five patients showing sustained improvements. CONCLUSION: Microvascular decompression of the left rostral ventrolateral medulla oblongata may be an effective treatment modality for patients suffering from severe HTN and/or autonomic dysreflexia refractory to medical management.

Adult↗
PubMed1999

Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression.

OBJECTIVES: We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms and functional results in patients with cervical spondylotic myelopathy who underwent anterior decompressive operations. Additionally, we sought to determine which findings had predictive value for surgical outcome. METHODS: We retrospectively reviewed the records of 76 patients with cervical spondylotic myelopathy caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion performed by one surgeon. The patients were evaluated postoperatively by office visits and/or telephone interviews. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. RESULTS: The most common preoperative symptoms were deterioration of hand use (75%), upper extremity sensory complaints (82.9%), and gait difficulties (80.3%). In the upper extremities, preoperative weakness was most common in the hand intrinsic muscles (56.6%) and triceps (28.9%), and in the lower extremities, preoperative weakness was most common in the iliopsoas (38.8%) and quadriceps (26.3%). In the lower extremities, individual muscle groups had strength improvement rates from 79.1 to 88.1 %; somewhat higher rates, from 81.3 to 90.9%, were observed in the upper extremities. When evaluated by using the Cooper myelopathy scale, lower extremity functional improvement occurred in 46.7% of the patients and upper extremity functional improvement in 75.4%. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale, was noted in 79.7% of the patients who had abnormal scores preoperatively. CONCLUSION: Strength improved at rates of approximately 80 to 90% in individual muscle groups after anterior cervical decompression. However, fewer than half of all patients experienced functional improvement in the lower extremities, a discrepancy that was probably caused by persistent spasticity rather than muscle weakness. Postoperative dysfunction in the upper extremities was caused by residual weakness as well as sensory loss. Recurrent symptomatic spondylosis at unoperated levels was calculated to occur at an incidence of 2% per year.

Adult↗
PubMed2001

Posterior fossa decompression and clot evacuation for fourth ventricle hemorrhage after aneurysmal rupture: case report.

OBJECTIVE AND IMPORTANCE: Massive intraventricular hemorrhage due to aneurysmal rupture is associated with a dismal prognosis. An intraventricular clot causing fourth ventricle dilation can cause compression to the brainstem similar to other posterior fossa masses such as cerebellar hemorrhage or infarction. The presence of fourth ventricle dilation carries a very high risk of death within 48 hours. Neither ventricular drainage nor fibrinolytic infusion has been successful in eliminating clots of the fourth ventricle. Posterior fossa decompression and direct evacuation of the clot could have good results in relieving brainstem compression caused by the clot. CLINICAL PRESENTATION: A 45-year-old woman was admitted to our intensive care unit after experiencing an aneurysmal subarachnoid hemorrhage. The neurological examination at admission revealed that she was in Grade V according to the World Federation of Neurological Surgeons grading system, but brainstem reflexes were present. Computed tomographic scanning revealed a massive intraventricular hemorrhage, with fourth ventricle dilation caused by an intraventricular clot. Bilateral external ventricular drains were placed to relieve elevated intracranial pressure. Cerebral angiography revealed a 1-cm basilar tip aneurysm, which was embolized with Guglielmi detachable coils (Boston Scientific, Boston, MA) during the same procedure. INTERVENTION: Given the patient's poor neurological condition, it was decided that brainstem compression should be relieved. A posterior fossa decompressive craniectomy was performed immediately after coil therapy, with direct evacuation of the intraventricular clot. The patient experienced a clear improvement in the level of consciousness and has achieved a good neurological result at early follow-up. CONCLUSION: Dilation of the fourth ventricle by an intraventricular clot is a sign of brainstem compression that can be relieved by posterior fossa decompression and direct clot evacuation.

Aneurysm, Ruptured↗
PubMed2001

Delayed resolution of residual hemifacial spasm after microvascular decompression operations.

OBJECTIVE: After microvascular decompression to treat hemifacial spasm (HFS), resolution of the HFS is often gradual. We carefully investigated the course of the gradual resolution of HFS and examined the differences between patients with and without postoperative HFS. METHODS: One hundred seventy-five patients with HFS were monitored, for observation of 1) whether postoperative HFS occurred, 2) when it occurred, and 3) when it disappeared after microvascular decompression. For two groups of patients, with (Group I) and without (Group II) postoperative HFS, we investigated age, sex, spasm side, preoperative facial nerve block (botulinum toxin treatment), decompression material, preoperative HFS period, offender (compressing vessel), temporary and permanent postoperative complications, and electromyographic findings. RESULTS: In Group I (88 patients), postoperative HFS began within 4 days after surgery, a period that we have termed the silent period of postoperative HFS; the median value for the time to resolution was 28 days. The other 87 patients exhibited no postoperative HFS (Group II). There was a significantly higher incidence of postoperative facial weakness in Group II (Group II, 41.3%; Group I, 25.5%; P = 0.02 by logistic regression analysis). In Group I, there was no statistically significant relationship between the investigated parameters and the silent period or the postoperative HFS period, as determined by Cox proportional-hazards regression analysis, except for the number of preoperative facial nerve blocks. Electromyographic investigation of F waves revealed facial paresis during the silent period in a patient. CONCLUSION: Approximately 50% of patients with HFS exhibited residual spasm postoperatively. An immediate postoperative silent period of 4 days without spasm was characteristic. One-quarter, one-half, and 90% of the residual spasm resolved by 1 week, 1 month, and 8 months after surgery, respectively.

Adult↗
PubMed2001

Anterior decompression of the atlantoaxial vertebral artery to treat bow hunter's stroke: technical case report.

OBJECTIVE AND IMPORTANCE: Bow hunter's stroke is a symptomatic vertebrobasilar insufficiency caused by stenosis or occlusion of the vertebral artery at the C1C2 level with head rotation. No case of anterior decompression of the vertebral artery for surgical treatment of bow hunter's stroke has been reported. CLINICAL PRESENTATION: A 47-year-old male patient presented with repeated episodes of unconsciousness caused by turning his head approximately 40 degrees to the right; he recovered consciousness within approximately 10 seconds after his head was returned to the neutral position. Angiography revealed an occluded right vertebral artery and temporary occlusion of the left vertebral artery, at the level of the C2 transverse foramen, when the patient's head was turned approximately 40 degrees to the right. INTERVENTION: Anterior decompression of the left vertebral artery at the transverse foramen of the axis was performed. Postoperative angiography demonstrated sufficient flow in the left vertebral artery even when the neck was rotated. CONCLUSION: The patient was discharged without neurological deficits. We demonstrate that simple surgical untethering of the vertebral artery at the transverse foramen of the axis is an effective method of treatment that avoids the limitation of head rotation. The advantage of this procedure is that it does not result in postoperative restriction of the patient's neck movements. The anterior approach, with decompression of the transverse foramen of the axis, in the present case provided adequate exposure of the vertebral artery and resulted in a satisfactory outcome.

Angiography↗
PubMed1992

Tear film bubble formation after decompression.

Decompression disorders can occur after a reduction in environmental pressure due to dissolved gases forming bubbles in affected tissues. The objective of this study was to evaluate the use of tear film bubble formation as an indicator of decompression. Eleven subjects were exposed to a simulated dive to 30.48 m (100 ft) (in sea water) for 15 min. There was a significant (p < 0.001) increase in tear film bubble formation post-dive. This noninvasive technique may be of value in both research and clinical environments for monitoring decompression.

Decompression Sickness↗
PubMed2000

Treatment of diabetic neuropathy by decompression of the posterior tibial nerve.

A series of 58 operations on 36 patients were performed for decompression of the posterior tibial nerve for the treatment of diabetic neuropathy. Preoperative symptoms included lack of sensation, pain, or both. Eleven of the 36 patients had neurotrophic ulcers, which were treated simultaneously. The operation was found to be effective for relief of pain in 24 of the 28 patients with that complaint (86 percent). Restoration of sensation was less consistent with improvement noted in 18 of the 36 patients (50 percent). The follow-up period ranged from 12 to 84 months (mean, 32 months) and five patients had some degree of recurrent symptoms. No patient has developed a new ulcer after nerve decompression. Wound complications were minimal (12 percent), even though ulcers were treated simultaneously. No patient required surgical treatment for the decompression incision, although one did require hospital admission for treatment of a wound infection. In general, the procedure seemed to be a worthwhile treatment, which should be considered ill selected diabetics with symptomatic neuropathy.

Decompression, Surgical↗
PubMed1999

Surgical decompression of branch retinal vein occlusion via arteriovenous crossing sheathotomy: a prospective review of 15 cases.

BACKGROUND: Branch retinal vein occlusion (BRVO), the second most common vascular disorder of the retina, typically occurs at arteriovenous (A/V) crossings where the arteriole and venule share a common adventitial sheath. Mechanical narrowing of the venous lumen at these intersections is thought to play a pathoetiologic role in BRVO. METHODS: We performed surgical decompression of BRVO via A/V crossing sheathotomy in 15 patients with decreased visual acuity due to macular hemorrhage, edema, and ischemia. Reperfusion of the retina was achieved by surgically separating the overlying retinal arteriole from the venule via vitrectomy and adventitial sheathotomy techniques. RESULTS: Intraoperative decompression of the A/V crossing was achieved in all 15 patients. All patients showed clinical improvement as determined by fundus examination, photography, and fluorescein angiography. Postoperative visual acuities were equal or improved in 80% of patients. Ten of the 15 subjects (67%) had improved visual acuity with an average gain of four lines of vision. CONCLUSION: Surgical decompression of BRVO via A/V crossing sheathotomy is a technically feasible procedure that can result in rapid reperfusion of the retina. Resolution of macular hemorrhage, edema, and ischemia may improve visual prognosis in patients with this common retinal vascular disorder.

Aged↗
PubMed1995

Decompression sickness in a private pilot.

Although safe, civil aviation can result in some unique medical problems. Most physicians are not familiar with aviation-related medical problems. One such problem, decompression sickness, is not mentioned in most medical texts, and is not included in most medical school instruction. If not promptly recognized and treated, decompression sickness can result in permanent disability or death. I report a case of altitude-induced decompression sickness after a flight in an unpressurized aircraft.

Aerospace Medicine↗
PubMed1997

1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation.

STUDY DESIGN: This prospective study analyzed the influence of transpedicular instrumented on the operative treatment of patients with degenerative spondylolisthesis and spinal stenosis. OBJECTIVES: To determine whether the addition of transpedicular instrumented improves the clinical outcome and fusion rate of patients undergoing posterolateral fusion after decompression for spinal stenosis with concomitant degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA: Decompression is often necessary in the treatment of symptomatic patients who have degenerative spondylolisthesis and spinal stenosis. Results of recent studies demonstrated that outcomes are significantly improved if posterolateral arthrodesis is performed at the listhesed level. A meta-analysis of the literature concluded that adjunctive spinal instrumentation for this procedure can enhance the fusion rate, although the effect on clinical outcome remains uncertain. METHODS: Seventy-six patients who had symptomatic spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied. All patients underwent posterior decompression with concomitant posterolateral intertransverse process arthrodesis. The patients were randomized to a segmental transpedicular instrumented or noninstrumented group. RESULTS: Sixty-seven patients were available for a 2-year follow-up. Clinical outcome was excellent or good in 76% of the patients in whom instrumentation was placed and in 85% of those in whom no instrumentation was placed (P = 0.45). Successful arthrodesis occurred in 82% of the instrumented cases versus 45% of the noninstrumented cases (P = 0.0015). Overall, successful fusion did not influence patient outcome (P = 0.435). CONCLUSIONS: In patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws may lead to a higher fusion rate, but clinical outcome shows no improvement in pain in the back and lower limbs.

Aged↗