Decompression Alone Versus Decompression and Fusion for Lumbar Degenerative Spondylolisthesis: A Meta-Analysis

Chen, Zihao; Xie, Peigen; Feng, Feng; Chhantyal, Kishor; Yang, Yang; Rong, Limin

doi:10.1016/j.wneu.2017.12.009

Cited by 35 publications

(31 citation statements)

References 40 publications

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“…20,21,23 A recent meta-analysis of 3 randomized con- trolled trials and 3 observational studies showed no benefit of adding fusion in the treatment of spondylolisthesis in terms of patient satisfaction. 11 However, it is important to note that several independent observational studies have demonstrated the beneficial role of adding instrumented fusion for patients undergoing surgical intervention for degenerative spondylolisthesis. 1,3,8,9,17 Some notable associations with patient satisfaction previously identified but not found to be significant in our cohort are worth discussing here.…”

Section: Discussionmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the “value”-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1–4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5–9] vs 8 [6–9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09–2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27–3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30–4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

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Section: Discussionmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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Section: Spondylolisthesismentioning

confidence: 99%

“…Complications from spinal fusion surgery for low back pain are common. One moderate-quality review 4 estimated the rate of early surgical complications to be 16% (95% CI [12][13][14][15][16][17][18][19][20]. A more recent low-quality review 13 estimated that complications such as infections, thrombosis, nerve root injury by pedicle screw and major bleeding are much greater with surgery (relative risk (RR) 22.11 (95% CI 5.99-81.60).…”

Section: Low Back Pain and Degenerative Disc Diseasementioning

confidence: 99%

“…A 2018 systematic review considered to be of low quality, identified four RCT that had investigated the value of fusion over decompression alone for degenerative spondylolisthesis. 18 All four trials included participants with spinal stenosis in addition to spondylolisthesis). [19][20][21][22] One trial also included participants without spondylolisthesis but they were randomised separately, and results were also presented separately.…”

Section: Spondylolisthesismentioning

confidence: 99%

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Lumbar spine fusion: what is the evidence?

Harris

Traeger

Stanford

et al. 2018

Internal Medicine Journal

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Lumbar spine fusion is a common procedure associated with a high cost burden and risk of serious complications. We aimed to summarise systematic reviews on the effectiveness of lumbar spine fusion for most diagnoses. We found no high‐quality systematic reviews and the risk of bias of the randomised controlled trials in the reviews was generally high. The available evidence does not support a benefit from spine fusion compared to non‐operative alternatives for back pain associated with degeneration. The available evidence does not support a clinical benefit from spine fusion compared to non‐operative treatment or stabilisation without fusion for thoracolumbar burst fractures. Benefits of spine fusion compared to non‐operative treatment for isthmic spondylolisthesis are unclear (one trial at high risk of bias). Surgical intervention for metastatic carcinoma of the spine associated with spinal cord compromise improves mobility and neurological outcome (based on a single trial). Better evidence is required to determine more accurately the effectiveness of spine fusion surgery for all indications. Patients contemplating spinal fusion should be fully informed about the evidence base for their particular problem, including the relative potential benefits and harms of fusion compared with non‐operative treatments.

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“…A cirurgia com fusão inter-somática isolada mostrou resultados semelhantes em médio e longo prazo em relação às avaliações de dor e incapacidades ODI, EQ-5D, SF-36 (p>0,05). Esses achados evidenciaram dados equiparáveis em termos de taxas de re-operação em longo prazo, porém com menor perda de sangue e menor custo, e similares resultados nas avaliações ODI e teste de caminhada de 6 minutos44,46,50 .Resultados semelhantes foram encontrados porSigmundsson et al, os quais avaliaram 1624 pacientes após cirurgia de descompressão de estenose espinhal, com e sem fusão de estruturas posteriores. Após 2 anos de acompanhamento, os resultados de melhora em dor lombar e em membros inferiores se mostraram similares 51 .…”

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Avaliação clínica e radiográfica de pacientes com estenose do canal lombar submetidos a técnica de artrodese lateral minimamente invasiva

Coutinho¹

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Alexandre Fogaça Cristante, professor e líder, um dos responsáveis pela minha formação em cirurgia de coluna e principalmente pelo incentivo científico. Minha admiração e respeito pela pessoa, profissional e grande caráter que possui. Ao Professor Dr. Tarcísio Eloy P. de Barros Filho, a admiração pela competência, coordenação e liderança de um dos maiores grupos de cirurgiões do Brasil. Ao Professor Dr. Raphael Martus Marcon, pelo guia técnico em cirurgias, fica também a admiração. Ao Professor Dr. Luiz Henrique Mattos Pimenta, importantíssimo na minha formação e transformação de um ortopedista em um cirurgião de coluna; um tutor, o qual me fez pensar em sempre buscar algo que seja melhor para oferecer aos meus pacientes através de ciência e novas tecnologias, além de um elo com outros profissionais de excelência no assunto. Ao Dr Frank Phillips, responsável por uma nova experiência, não só em cirurgia da coluna, mas de vida. Ao Dr Alexandre Sadao Iutaka, pela apresentação e pela minha introdução num local de trabalho onde consigo praticar medicina de mais alto nível, fica a eterna gratidão.

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Decompression Alone Versus Decompression and Fusion for Lumbar Degenerative Spondylolisthesis: A Meta-Analysis

Cited by 35 publications

References 40 publications

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Lumbar spine fusion: what is the evidence?

Avaliação clínica e radiográfica de pacientes com estenose do canal lombar submetidos a técnica de artrodese lateral minimamente invasiva

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