Indication of Fusion for Lumbar Spinal Stenosis in Elderly Patients and Its Significance

Yone, Kazunori; Sakou, Takashi; Kawauchi, Yosihisa; Yoshizumi, Masao; Yanase, Mitsuhiro

doi:10.1097/00007632-199601150-00016

Cited by 126 publications

(78 citation statements)

References 12 publications

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“…Further, and in contrast to the present study, none of the observational studies declared using a consecutive series of all eligible patients. Three papers from Japan used JAO scores [15,21,27] and one used ODI and SF 36 [5]. To pool the data, an attempt was made to dichotomise each clinical outcome into ''satisfactory'' or ''not satisfactory'', since the various outcome instruments were not comparable.…”

Section: Discussionmentioning

confidence: 99%

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

et al. 2011

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Introduction Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)]. Methods 213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months' follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0-10 leg-pain (LP) and LBP scales. At 12 months' FU, patients rated global outcome which was then dichotomised into ''good'' and ''poor''. Results Pre-operatively, LBP and COMI scores were significantly worse (p \ 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months' FU was significantly greater for D&F than for D (p \ 0.001) and was not influenced by the patient's declared ''main problem'' at baseline (back pain, leg pain, or neurological disturbances) (p [ 0.05). There was a higher proportion (p = 0.01) of ''good'' outcomes at 12 months' FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome). DiscussionOur study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.

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Section: Discussionmentioning

confidence: 99%

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

et al. 2011

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“…However, there are many papers with class II and III evidence levels advocating concomitant spinal fusion and arthrodesis to improve outcomes and avoid late instabilities, even in patients without spondylolisthesis or spinal deformities [29][30][31][32][33][34] . It is known that when more than 30% of the articular facets are removed bilaterally, we have a greater probability of developing late instability, justifying fusion in patients subjected to large decompressive surgeries 35 .…”

Section: Surgical Treatmentmentioning

confidence: 99%

Degenerative lumbar stenosis: update

Joaquim

Sansur

Hamilton

et al. 2009

Arq. Neuro-Psiquiatr.

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-We present a literature review of the diagnosis and treatment of acquired lumbar spinal stenosis (LS), with a brief description of new surgical techniques. LS is the most common cause of spinal surgery in individuals older than 65 years of age. Neurogenic claudication and radiculopathy result from compression of the cauda equina and lumbosacral nerve roots by degenerated spinal elements. Surgical decompression is a well established treatment for patients with refractory, or moderate to severe clinical symptoms. However, the variety of surgical options is vast. New techniques have been developed with the goal of increasing long term functional outcomes. In this article we review lumbar decompression and fusion as treatment options for LS but also present other recent developments. Prospective long term studies are necessary to know which procedures would result in optimal patient outcome.Key WordS: acquired lumbar stenosis, surgical treatment, new techniques, fusion. estenose lombar degenerativa: atualização resumo -Apresentamos uma revisão de literatura do diagnóstico e tratamento da estenose lombar (eL) adquirida, enfatizando as novas técnicas de manejo cirúrgico. A eL é a causa mais comum de cirurgia na coluna de pacientes com mais de 65 anos de idade. Claudicação neurogênica e radiculopatias são sintomas resultantes da compressão das raízes lombossacrais pelos elementos degenerados. A descompressão cirúrgica é um procedimento bem estabelecido para pacientes com sintomas severos ou refratários ao tratamento clínico. Contudo, as opções cirúrgicas são amplas. Novas técnicas de fusão e artrodese são úteis para melhorar os resultados funcionais. Neste artigo, varias alternativas cirúrgicas são apresentadas, incluindo as novas tecnologias na área. evidências científicas mais contundentes com seguimento longo são necessárias para a incorporação destas práticas na atividade médica de rotina.PALAvrAS-CHAve: estenose lombar adquirida, tratamento cirúrgico, novas técnicas, fusão.

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“…The main objective of this review was to analyze the benefit of concomitant fusion in decompressive surgery for DS (Martin et al 2007). Based on two RCT's (Herkowitz and Kurz 1991;Bridwell et al 1993) and 5 observational studies (Feffer et al 1985;Lombardi et al 1985;Satomi et al 1992;Yone et al 1996;Ghogawala et al 2004) it was concluded that a concomitant fusion in DS surgery conferred a better outcome than decompression without fusion. The two cited RCT's (Herkowitz and Kurz 1991;Bridwell et al 1993) were however noticeably flawed in their design in terms of randomization (pseudo-randomized or not described adequately), blinding (not described) and the lack of validated general or specific patient related outcome measures as end point variables (Martin et al 2007).…”

Section: Spinal Fusion and Outcomementioning

confidence: 99%

“…The few retrospective studies that have analyzed outcome of decompression compared to decompression and fusion in patients with DS include few patients, seldom with consecutive inclusion, patients with and without additional scoliosis, and rarely use validated outcome measures (Feffer et al 1985;Lombardi et al 1985;Satomi et al 1992;Yone et al 1996). In spite of a low level of evidence, it is worth noting that these studies usually favor fusion in DS.…”

Section: The Role Of Spinal Fusion In Dsmentioning

confidence: 99%

Determinants of outcome in lumbar spinal stenosis surgery

Sigmundsson¹

2014

Acta Orthopaedica

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Cover illustration: "Spine Talk", acryl paint on stretched canvas. The painting was created in 2008 by the Canadian artist Barbara C. St Jean and is a painting of two people talking to each other over top of a spine of another. The painting was created to illustrate the problems associated with back pain and the discussions with medical professionals over the causes and treatment options. By permission from the artist.

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Indication of Fusion for Lumbar Spinal Stenosis in Elderly Patients and Its Significance

Abstract: The definition of instability by Posner's method proved useful for selecting elderly patients with instability for fusion treatment. Fusion with instrumentation should be performed on elderly patients with instability after decompression.

Cited by 126 publications

References 12 publications

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

Degenerative lumbar stenosis: update

Determinants of outcome in lumbar spinal stenosis surgery

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