Circumferential Fusion Improves Outcome in Comparison With Instrumented Posterolateral Fusion: Long-term Results of a Randomized Clinical Trial

Videbaek, Tina S.; Christensen, Finn Kjær; Soegaard, Rikke; Hansen, Ebbe Stender; Høy, Kristian; Helmig, Peter; Niedermann, Bent; Eiskjoer, Søren P; Bünger, Cody

doi:10.1097/01.brs.0000247793.99827.b7

Cited by 132 publications

(72 citation statements)

References 18 publications

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“…However, the low prevalence of severe ASD and the limited effect on outcome observed in this study do not seem to fully explain the previously demonstrated decline of outcome at long-term follow-up. In contrast to our results, two long term Danish studies on DDD without non-operated controls showed no deterioration of outcome 10-13 and 5-9 years post-operatively, respectively [1,51]. The reason for this discrepancy is unclear, but differences in diagnosis as well as type of fusion may apply.…”

Section: Discussioncontrasting

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.

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Section: Discussioncontrasting

confidence: 99%

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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“…4). Clinical result analysis demonstrated a significant improvement in function and lumbar and leg pain relief with a high rate of satisfaction similar to other series of degenerative lumbar surgery in younger patients [28].…”

Section: Discussionsupporting

confidence: 74%

Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

et al. 2011

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Introduction Lumbar fusion in elderly patients is increasingly common. This study prospectively investigated the clinical and radiological outcome of osteoporotic patients [70 years with degenerative lumbar instability treated with fusion using a new cannulated, cemented, pedicle screw instrumentation augmented with PMMA. Materials and Methods The surgical protocols, patient records, densitometry, imaging studies, and pre-and postoperative patient-reported outcome questionnaires of 23 patients (mean age, 77 years) with a follow-up of 20-49 months were reviewed. All patients underwent postoperative 3D CT scan control to assess cement leakage and instrumentation position. Serial radiological controls were analyzed for secondary complications, i.e., adjacent fractures, hardware mobilization and radiological evidence of fusion. Results Pain and function improved at 6 months and were maintained at the final follow-up. No clinical complications secondary to PMMA leakage developed. No clinical or radiological cases of non-union were observed with a mean of 1.8 levels fused. No fractures occurred in adjacent segments. There were four cases of adjacent disc disease. Three deep infections required surgical revision without removal of material and one superficial infection, all with complete remission. ConclusionThis new instrumentation for degenerative lumbar disease in elderly patients is safe and effective.

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“…In the absence of clinical differences, cages augmented with autogenous cancellous bone show similar mechanical characteristics to structural bone grafts [6,18,40]. Fusion rates of up to 100% have been achieved with these methods according to the literature [28,35,40].…”

Section: Introductionmentioning

confidence: 97%

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

et al. 2009

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Circumferential Fusion Improves Outcome in Comparison With Instrumented Posterolateral Fusion: Long-term Results of a Randomized Clinical Trial

Cited by 132 publications

References 18 publications

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

Instrumented lumbar arthrodesis in elderly patients: prospective study using cannulated cemented pedicle screw instrumentation

Allogenic versus autologous cancellous bone in lumbar segmental spondylodesis: a randomized prospective study

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