Direct decompression may rapidly resolve radiculopathy symptoms compared to indirect Single Level Lumbar Fusion: study

Key findings of the study were:

• 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompressions (ID) (mean 54.6y, 61.4% female).

• Mean age of the direct decompression group was 53.9 ± 12.9 years with 67.2% of the sample being female.The average BMI was 30.3 ± 5.9 with mean CCI being 1.97 ± 2.01.

• Mean age of the indirect decompression group was 54.6 ± 12.6 years with 61.4% of the sample being female. The average BMI was 30.0 ± 6.3 with mean CCI being 2.1 ± 2.03.

• 76.7% of patients in the Direct group were diagnosed with degenerative spondylolisthesis, degenerative disk disease with spondylolisthesis, or pars fracture compared with 75% of the Indirect group.

• There were no differences in baseline canal diameter between groups (indirect: 10.311 ± 3.261 v Direct: 10.025 ± 3.704, P = .293)

• DD patients experienced greater blood loss than ID.

• Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op.

• By 6 months, DD patients demonstrated larger reductions in VAS score.

• With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients.

The authors concluded – “Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.” 

Study Design: Retrospective analysis.

Further reading:

Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion Walia et al Global Spine Journal 2024 DOI: 10.1177/21925682241230926