Clinical and radiological characteristics analysis of simple decompression surgery for patients with mild degenerative lumbar spondylolisthesis with lumbar spinal stenosis: a 5-year retrospective cohort study from a single center

Degenerative lumbar spondylolisthesis (DLS) with lumbar spinal stenosis (LSS) is a common spinal disorder in elderly patients. While fusion surgery has been considered the standard treatment for DLS, recent evidence suggests that decompression alone may be sufficient for mild cases. This study aimed to analyze the clinical and radiological characteristics of patients with mild DLS and LSS treated with simple decompression surgery. We retrospectively analyzed 178 patients with mild DLS (Meyerding grade I) and LSS who underwent simple decompression surgery at our center between January 2019 and December 2023. All patients had confirmed absence of dynamic instability on preoperative flexion–extension radiographs and predominant radicular symptoms from central canal and lateral recess stenosis . Clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) for back and leg pain, and patient satisfaction. Radiological parameters included slip percentage, disc height, segmental lordosis, and facet joint degeneration. Assessments were performed preoperatively and at 3, 12, and 24 months postoperatively. Significant improvements in ODI and VAS scores were observed postoperatively ( p < 0.001). All improvements exceeded the Minimal Clinically Important Difference thresholds . At the 24-month follow-up, 85.9% of patients reported good to excellent outcomes. Slip progression > 2 mm was observed in 23 patients (12.9%), but only 7 patients (3.9%) required revision surgery with fusion. Multivariate analysis identified preoperative disc height < 6 mm (OR = 2.83, 95% CI 1.54–5.21), facet joint tropism > 10° (OR = 3.12, 95% CI 1.85–5.27), and sagittal facet angle > 50° (OR = 2.41, 95% CI 1.32–4.39) as significant risk factors for slip progression. Simple decompression is an effective treatment for carefully selected patients with mild DLS and LSS who have stable spondylolisthesis without dynamic instability . Preoperative radiological parameters can help identify patients at risk for postoperative instability. For patients without significant risk factors, decompression alone provides satisfactory outcomes with lower morbidity compared to fusion procedures.