Decompression with or without fusion in degenerative adjacent segment stenosis after lumbar fusions

Abstract

Adjacent segment stenosis can occur after lumbar fusion surgery, leading to significant discomfort and pain. If further surgeries are required, the choice of the operative technique is an individual decision. In patients without over instability, it is still uncertain whether patients with adjacent spinal stenosis should be treated like primary lumbar spinal stenosis via decompressive surgery alone or with decompression and fusion. This is a retrospective analysis with prospective collected data. We included patients with adjacent segment stenosis after lumbar fusion. Patients with spinal deformity and/or obvious instability and/or significant neuroforaminal stenosis were excluded. All patients were divided into two groups according to the surgical technique that has been used: (a) treated via microsurgical decompression (MDG), (b) decompression and fusion of the adjacent segment (FG). Treatment decision was at discretion of the surgeon. Primary outcome was the need for further lumbar surgery after 1 year. In addition, patient reported outcome was measured via numerical rating scale (NRS), SF-36, Oswestry disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI), and General Depression Scale before and after 1 year after surgery. In a further follow-up, need for additional lumbar surgery was redetermined. Total study population was 37 patients with a median age of 72 years. A total of 86.1% of patients suffered from a proximal adjacent segment stenosis and most common level was L3/4 (51.4%). A total of 61.1% of included patients developed adjacent segment stenosis after fusion of one single lumbar segment. Eighteen patients were included in MDG and 19 patients in FG. Both groups benefited from surgical interventions and there was no significant difference concerning pain, pain associated disability, sleeping, life quality, and mood after 1 year or the need of follow-up surgeries 1 year after primary fusion (5 in MDG vs. 5 in FG, p = 0.92) and at the second follow-up with a median time after surgery of 30 months (6 in MDG vs. 7 in FG, p = 0.823). Duration of surgery and hospital stay was significant shorter in MDG. There was no difference concerning operative complications rate. Both groups improved significantly in pain associated disability index, pain in motion, and concerning the sleeping quality. The present study indicates that decompression may not be inferior to decompression and fusion in patients suffering from degenerative adjacent segment stenosis without obvious signs of instability, deformation, and neuroforaminal stenosis after lumbar fusion in short-term follow-up. Due to significant shorter time of surgery, a pure microsurgical decompression may be a sufficient alternative to a decompression and fusion, particular regarding old age of this patient cohort.

ChatGPT and its Role in the Decision-Making for the Diagnosis and Treatment of Lumbar Spinal Stenosis: A Comparative Analysis and Narrative Review

“…These findings have been recently corroborated in the literature by multiple studies. 25 , 27 , 28 Once again, ChatGPT presented a conservative recommendation to this question and emphasized that only patients that present with instability tend to get this operation. However, it once again presented within its response fictitious papers that could not be found in the literature.…”

Adjacent Segment Disease After Spinal Fusion

“…Therefore, Palejwala et al reserve minimally invasive surgery (MIS) decompression alone for patients whose likelihood of developing instability is low (e.g., no spondylolisthesis or significant malalignment) 53 . This is supported by Früh et al, who retrospectively compared microsurgical decompression with decompression and fusion for patients with adjacent segment stenosis without instability, deformation, and neuroforaminal stenosis 55 . Both groups benefitted from surgical intervention with no difference in complication rates, suggesting that in patients, decompression may not be inferior to compression and fusion.…”

Transforaminal Endoscopic Lumbar Foraminotomy for Juxta-Fusional Foraminal Stenosis

“…Orita et al [4] reported that, during an average follow-up of 13.3 months after floating fusion surgery, adjacent L5-S1 foraminal stenosis was found in eight of 125 patients (6.4%). Adjacent level foraminal stenosis is one of the primary causes of intractable radiculopathy after fusion surgery [9][10][11].…”