Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease

Divi, Srikanth N.; Schroeder, Gregory D.; Goyal, Dhruv K.C.; Radcliff, Kris; Galetta, Matthew S.; Hilibrand, Alan S.; Anderson, D. Greg; Kurd, Mark F.; Rihn, Jeffrey A.; Kaye, I. David; Woods, Barrett; Vaccaro, Alexander R.; Kepler, Christopher K.

doi:10.1016/j.spinee.2019.07.014

Cited by 26 publications

(26 citation statements)

References 27 publications

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“…Most variables related to the surgery, such as type of interbody fusion performed, segments intervened, and duration of post-surgery hospitalization, do not influence the functional outcome in our cohort, as also reported by others [ 13 , 20 ]. Srikanth et al and Mobbs et al [ 1 , 20 ] both report that the type of surgery does not impact the outcome, so the surgical approach is done according to advantages, disadvantages, and limitations at the surgical level tailored for each patient. In our cohort, patients undergoing TLIF and PLIF had similar results supporting the previously published claims.…”

Section: Discussionsupporting

confidence: 85%

Assessment of Functional Outcome Predictors in Patients Undergoing Lumbar Interbody Fusion Surgery: A Single-Centre Analysis

Marques¹,

Gomes²,

Nogueira³

et al. 2022

Cureus

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Introduction Lumbar interbody fusion is a surgical modality performed in selected patients with low back and radicular pain not responding to medical therapy. We aim to evaluate the main predictors of functional outcome, assessed through Oswestry Disability Index (ODI), in patients submitted to a lumbar interbody fusion. Methods A sample of 33 patients undergoing lumbar interbody fusion at a neurosurgery department between 2017 and 2020 was selected. In order to assess functional status, ODI was applied before and after surgery. Data related to patients' medical history, current disease, and surgery performed were collected from the clinical process. Results In our cohort, functional improvement (pre-surgery ODI - post-surgery ODI) averaged 34.4 ± 23 points, suggesting robust surgical efficacy. We find patients with severe disability or worse to display relevant amelioration of their functional scores (p<0.0001), suggesting that these can benefit from lumbar interbody fusion surgery. The female gender (p=0.007) predicts a better outcome, which was surprising as no sex differences in lumbar fusion outcomes have been reported. Conversely, early symptom recurrence (p=0.015) and need for revision surgery (p=0.032) were found to be negative predictors of post-surgical functional outcome. Rapid return to the activities of daily living (p=0.001) and to work (p=0.002) was associated with post-surgical functional improvement. The underlying diagnosis that led to surgical referral and surgical modality did not affect the functional outcome in our patient cohort. Importantly, patients with previous lumbar surgeries had similar improvements to those who had never been operated on. Conclusions Severely disabled patients submitted to lumbar interbody fusion showed significant functional improvement, regardless of the referral diagnosis or the existence of previous lumbar surgeries. Additionally, sustained functional improvement resulted in a return to an active life.

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Section: Discussionsupporting

confidence: 85%

Assessment of Functional Outcome Predictors in Patients Undergoing Lumbar Interbody Fusion Surgery: A Single-Centre Analysis

Marques¹,

Gomes²,

Nogueira³

et al. 2022

Cureus

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“…Both surgical and nonoperative treatments are possible. The former usually involves various types of fusion and stabilization techniques, of which none has yet proven to be superior [5,18,34]. Despite the progress made in our understandings of the disease, it has still to be fully established when (and possibly also whether) surgical intervention is superior to conservative treatment [2,7,11].…”

Section: Introductionmentioning

confidence: 99%

Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80 s: comparative study with over 60 s and 70 s. Experience with 678 cases

et al. 2022

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Purpose Degenerative spondylolisthesis (DS) is a debilitating condition that carries a high economic burden. As the global population ages, the number of patients over 80 years old demanding spinal fusion is constantly rising. Therefore, neurosurgeons often face the important decision as to whether to perform surgery or not in this age group, commonly perceived at high risk for complications. Methods Six hundred seventy-eight elder patients, who underwent posterolateral lumbar fusion for DS (performed in three different centers) from 2012 to 2020, were screened for medical, early and late surgical complications and for the presence of potential preoperative risk factors. Patients were divided in three categories based on their age: (1) 60–69 years, (2) 70–79 years, (3) 80 and over. Multiple logistic regression was used to determine the predictive power of age and of other risk factors (i.e., ASA score; BMI; sex; presence or absence of insulin-dependent and -independent diabetes, use of anticoagulants, use of antiaggregants and osteoporosis) for the development of postoperative complications. Results In univariate analysis, age was significantly and positively correlated with medical complications. However, when controls for other risk factors were added in the regressions, age never reached significance, with the only noticeable exception of cerebrovascular accidents. ASA score and BMI were the two risk factors that significantly correlated with the higher numbers of complication rates (especially medical). Conclusion Patients of different age but with comparable preoperative risk factors share similar postoperative morbidity rates. When considering octogenarians for lumbar arthrodesis, the importance of biological age overrides that of chronological.

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“…11,18,19,[23][24][25] A direct comparison with most of these studies may not be conclusive because they included only patients with spondylolisthesis, performed single-level interbody fusion even when multiple levels were decompressed, or limited the PLF to one side. The studies by Høy et al 23 and Divi et al 25 are methodologically closest to ours; however, they included patients with degenerative disc disease, listhesis, spinal stenosis, or failed back surgery, whereas we included only patients with spinal stenosis with no prior surgery. Furthermore, although they decompressed multiple segments, they did not perform an analysis based on the number of fused segments, whereas we stratified the outcome based on the number of fused segments.…”

Section: Discussionmentioning

confidence: 99%

“…As patients' age and preoperative morbidities increase, surgeons tend to prefer PLF over TLIF because of its technical ease, resulting in younger patients in the TLIF group. 25 Limitations of our study include its retrospective design, substantial loss to followup, use of different cages, and possible effects of confounding variables such as osteoporosis, infection, smoking, hormonal imbalance, corticosteroid or nonsteroidal anti-inflammatory drug use, and chemotherapy. Another limitation is that we did not have a postoperative computed tomography scan of each patient, which could have yielded different results than the Brantigan-Steffee classification.…”

Section: Discussionmentioning

confidence: 99%

Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

et al. 2020

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Objective This study was performed to compare fusion rates and clinical outcomes of posterior decompression by posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spinal stenosis. Methods This retrospective cohort study involved 157 patients with lumbar spinal stenosis treated with instrumented PLF alone or instrumented PLF combined with TLIF from 2010 to 2018. The patients were divided into two groups: the PLF group (Group A), in which posterior decompression with instrumented PLF was performed, and the cage-augmented group (Group B), in which TLIF was added to the procedures described for the PLF group. Patient outcomes (Oswestry Disability Index, visual analog scale score, and 36-Item Short-Form Health Survey scores) and fusion rates were compared. Results The fusion rate was similar between the two groups. Among patients with two- and three-level fusion, improvements in the clinical outcome scores were significantly greater in Group B than Group A. Conclusion Combining TLIF with PLF provides better clinical outcomes than PLF alone when multilevel fusion is indicated. TLIF augmentation does not improve the fusion rates in either single- or multi-level surgery.

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Fusion technique does not affect short-term patient-reported outcomes for lumbar degenerative disease

Cited by 26 publications

References 27 publications

Assessment of Functional Outcome Predictors in Patients Undergoing Lumbar Interbody Fusion Surgery: A Single-Centre Analysis

Assessment of Functional Outcome Predictors in Patients Undergoing Lumbar Interbody Fusion Surgery: A Single-Centre Analysis

Complications of degenerative lumbar spondylolisthesis and stenosis surgery in patients over 80 s: comparative study with over 60 s and 70 s. Experience with 678 cases

Augmenting posterolateral fusion with transforaminal lumbar interbody fusion cage improves clinical outcome, but not fusion rate, of posterior decompression

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