J Korean Soc Geriatr Neurosurg > Volume 16(1); 2020 > Article
Journal of Korean Society of Geriatric Neurosurgery 2020;16(1):52-57.
DOI: https://doi.org/10.51638/jksgn.20.00367    Published online September 30, 2020.
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
Woo Man Jeon, Young Woo Shim, Won Hee Lee, Sung Tae Kim, Keun Soo Lee, Sung Hwa Paeng, Yung Kyun Jung, Moo Seong Kim, Yong Tae Jung, Se Young Pyo
Department of Neurosurgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
양측 하지방사통을 갖는 척추전방전위증 노인 환자에서 후궁전절제술 후 추간공 경유 요추체 유합술과 관상확장기를 이용한 일측접근하 양측 감압술 후 추간공 경유 요추체 유합술의 임상적 비교
전우만, 심용우, 이원희, 김성태, 이근수, 팽성화, 정영균, 김무성, 정용태, 표세영
인제대학교 의과대학 부산백병원 신경외과학교실
Correspondence:  Se Young Pyo, Tel: +82-51-890-6144, Fax: +82-51-898-4244, 
Email: Pyo-ns@hamail.net
Abstract
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.
Key Words: Laminectomy, Radiculopathy, Spinal fusion, Spondylolisthesis
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