• Karsten Schöller, Marjan Alimi, Guang-Ting Cong, Paul Christos, and Roger Härtl.
• Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, USA.
• Neurosurgery. 2017 Mar 1; 80 (3): 355-367.

BackgroundDecompression without fusion is a treatment option in patients with lumbar spinal stenosis (LSS) associated with stable low-grade degenerative spondylolisthesis (DS). A minimally invasive unilateral laminotomy (MIL) for "over the top" decompression might be a less destabilizing alternative to traditional open laminectomy (OL).ObjectiveTo review secondary fusion rates after open vs minimally invasive decompression surgery.MethodsWe performed a literature search in Pubmed/MEDLINE using the keywords "lumbar spondylolisthesis" and "decompression surgery." All studies that separately reported the outcome of patients with LSS+DS that were treated by OL or MIL (transmuscular or subperiosteal route) were included in our systematic review and meta-analysis. The primary end point was secondary fusion rate. Secondary end points were total reoperation rate, postoperative progression of listhetic slip, and patient satisfaction.ResultsWe identified 37 studies (19 with OL, 18 with MIL), with a total of 1156 patients, that were published between 1983 and 2015. The studies' evidence was mostly level 3 or 4. Secondary fusion rates were 12.8% after OL and 3.3% after MIL; the total reoperation rates were 16.3% after OL and 5.8% after MIL. In the OL cohort, 72% of the studies reported a slip progression compared to 0% in the MIL cohort, respectively. After OL, satisfactory outcome was 62.7% compared to 76% after MIL.ConclusionIn patients with LSS and DS, minimally invasive decompression is associated with lower reoperation and fusion rates, less slip progression, and greater patient satisfaction than open surgery.Copyright © 2017 by the Congress of Neurological Surgeons

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