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Lumbar Degenerative Spondylolisthesis

Changes in Surgical Indications and Comparison of Instrumented Fusion With Two Surgical Decompression Procedures

Inui, Toshihiko, MD; Murakami, Masahiro, MD; Nagao, Noriaki, MD; Miyazaki, Kouichi, MD; Matsuda, Kou, MD; Tominaga, Yoshiko, MD; Kitano, Masahiko, MD, PhD; Hasegawa, Hiroshi, MD, PhD; Tominaga, Shinsuke, MD, PhD


Re: “Lumbar Degenerative Spondylolisthesis: Changes in Surgical Indications and Comparison of Instrumented Fusion with Two Surgical Decompression Procedures”

Inui, Toshihiko; Murakami, Masahiro; Nagao, Noriaki; Miyazaki, Kouichi; Matsuda, Kou; Tominaga, Yoshiko; Kitano, Masahiko; Hasegawa, Hiroshi; Tominaga, Shinsuke Less

Spine. 42(1):E15-E24, January 1, 2017.

The following errors were published in the above mentioned article:

1: The title of the figure legend which explains bar graphs at E19 should be “Figure 4”, Therefore, the title of the figure legend which explains the photos of the lumber spine at E21 should be “Figure 3”

2: In Table 2, the p value “0.7296” is the p value for L3 to L5. Therefore, the line under the value “0.7296” should be removed to merge the cells.

3: The column titles of Table 3 were not fixed as we requested. The title of the column and separation line between columns 1–2 and 3 should be removed, so that title for columns 1 to 3 is “PreOp”.

The title for columns 4 to 6 should be “FFU,” which should be placed over column 3 (P/P), 4 (U/B) and 5 (p Value).

The title for columns 7 to 8 should be “PreOp Versus FFU P Value,” which should be placed over columns 7 (P/P) and 8 (U/B).

The row level of the titles “FFU” and “PreOp Versus FFU P Value” should be at the same level as “PreOp”. The column in which the word “JOA score recovery rate” appears should be merged, as shown in the corrected Tables file (Table 3).

4: For the corrected Tables file (Tables 2, 3, and 4), all P values in red ink should be centered both horizontally and vertically in the merged cells.

5: In the Tables file (Table 5), the ‘n = 19’ should be centered horizontally, as shown in red ink in the corrected Tables file (Table 5).

6: In Table 5, the word ‘PreOo to FFU; 6 to 5, 5 to 5. 6 to 5mm’ should be replaced with ‘PreOp to FFU; 6 to 5, 5 to 5. 6 to 5mm’, as shown in red ink in the corrected Tables file (Table 5).

Below are the corrected Tables 2, 3, 4 and 5 .

All corrections in the Tables (2, 3, 4 and 5) are written in red ink

Spine. 42(16):E992-E994, August 15, 2017.

doi: 10.1097/BRS.0000000000001688

Study Design. Single-center retrospective case series.

Objective. To compare outcomes of instrumented fusion and two methods of decompression for degenerative spondylolisthesis.

Summary of Background Data. There is no consensus on the surgical indications or optimum techniques for lumbar degenerative spondylolisthesis.

Methods. We analyzed the data of 140 patients treated by fusion (n = 80; mean follow-up, 77.9 months) or decompression (n = 60; mean follow-up, 38.0 months) and examined changes in surgical indications over a 12-year period. We compared the outcomes of instrumented fusion with the outcomes of two decompression techniques, the first employing a unilateral approach for bilateral decompression and the second employing a bilateral approach for contralateral decompression, with contralateral foraminal decompression as needed. Postoperative evaluation was made at the final follow-up visit beginning in 2007 by analyzing patient interviews and neurological examination data. We compared results with the Japanese Orthopedic Association symptom score before surgery and at final follow-up.

Results. Surgical indications for fusion narrowed over time, with fusion used less frequently and decompression used more frequently. Similar decreases in clinical symptoms, including low back pain, were achieved with all methods. In the decompression groups, preoperative slip distance and instability, and postoperative slip progression or development of instability, did not correlate significantly with clinical outcome. Slip progression occurred in 8 of 10 levels in patients with preoperative translation ≥5 mm, but these patients showed no increase in instability, defined as translation ≥ 2 mm, at final follow-up.

Conclusion. Our findings raise a question about the value of the radiologic criteria for performing fusion used in the late period, namely translation ≥5 mm and/or rotation ≥ 10°. If discogenic pain is excluded, decompression alone may be suitable even for patients with severe low back pain and translation ≥5 mm.

Level of Evidence: 4

Department of Neurosurgery, Tominaga Hospital, Naniwa-ku, Osaka-shi, Osaka, Japan.

Address correspondence and reprint requests to Toshihiko Inui, MD, Department of Neurosurgery, Tominaga Hospital, 1-4-48 Minatomachi, Naniwa-ku, Osaka-shi, Osaka 556-0017, Japan; E-mail:

Received 17 November, 2015

Revised 22 March, 2016

Accepted 25 April, 2016

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: payment for lectures, payment for development of educational presentations, travel/accommodations/meeting expenses.

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