Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: Lumbar fusion for stenosis with spondylolisthesis

Abstract

<jats:p>Patients presenting with stenosis associated with a spondylolisthesis will often describe signs and symptoms consistent with neurogenic claudication, radiculopathy, and/or low-back pain. The primary objective of surgery, when deemed appropriate, is to decompress the neural elements. As a result of the decompression, the inherent instability associated with the spondylolisthesis may progress and lead to further misalignment that results in pain or recurrence of neurological complaints. Under these circumstances, lumbar fusion is considered appropriate to stabilize the spine and prevent delayed deterioration. Since publication of the original guidelines there have been a significant number of studies published that continue to support the utility of lumbar fusion for patients presenting with stenosis and spondylolisthesis. Several recently published trials, including the Spine Patient Outcomes Research Trial, are among the largest prospective randomized investigations of this issue. Despite limitations of study design or execution, these trials have consistently demonstrated superior outcomes when patients undergo surgery, with the majority undergoing some type of lumbar fusion procedure. There is insufficient evidence, however, to recommend a standard approach to achieve a solid arthrodesis. When formulating the most appropriate surgical strategy, it is recommended that an individualized approach be adopted, one that takes into consideration the patient's unique anatomical constraints and desires, as well as surgeon's experience.</jats:p>

Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

“…1,4,7 For this reason, because conventional procedures for decompression involving surgical invasion of facet joints and surrounding soft tissue could increase instability and exacerbate clinical symptoms, decompression combined with fusion is recommended. Based on randomized controlled trials, Martin et al 10 recommend fusion using instrumentation while Resnick et al 18 recommend fusion as a guideline. It has also been reported, however, that there is no clear relationship between segmental instability and clinical symptoms.…”

Determinants of outcome in lumbar spinal stenosis surgery

“…To reach this goal experts in this field presently advocate shared decision making underlining the importance of a thorough discussion with the patient, particularly regarding their expectations with regards to a probable outcome of surgery (Kurd et al 2012;Pearson et al 2012). Furthermore, as RCT's are difficult and cumbersome to perform and their validty is undermined by crossover, experts recommend creation of patient registries to allow for prospective study of surgical outcome in lumbar degenerative disorders (Resnick et al 2014a;Resnick et al 2014b).…”

Clinical and radiological outcomes of spinal endoscopic discectomy–assisted oblique lumbar interbody fusion: preliminary results

“…5,11,14 Minimally invasive spinal fusion surgeries, such as mini-anterior lumbar interbody fusion (ALIF) and transforaminal lumbar interbody fusion (TLIF), are performed to minimize the injury to posterior lumbar myoligamentous structures. Minimally invasive lateral lumbar interbody fusion (LLIF) surgeries, such as direct lateral interbody fusion (DLIF) and oblique lumbar interbody fusion (OLIF), have been attempted recently to treat lumbar degenerative disease.…”