National Trends in the Use of Fusion Techniques to Treat Degenerative Spondylolisthesis

Ck, Kepler; Ar, Vaccaro; As, Hilibrand; Dg, Anderson; Ja, Rihn; Tj, Albert; Ke, Radcliff

doi:10.1097/brs.0000000000000486

Cited by 159 publications

(119 citation statements)

References 18 publications

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“…This number excluded device-related re-operations, which accounted in the meta-analysis for 25 %. Wound complications observed in our study are also in the range of reported values from 1.2 % [16] to 6 % [17]. Procedure reported complications were reported with an incidence of 5 %, implant related complications with an incidence of 1.1 %, non-union/delayed union at 0.1 % [17], and overall major medical complications were reported in 3.1 % of patients [16].…”

Section: Discussionsupporting

confidence: 72%

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

Garin

Boutrand

2016

International Orthopaedics (SICOT)

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Section: Discussionsupporting

confidence: 72%

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

Garin

Boutrand

2016

International Orthopaedics (SICOT)

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“…3 However, in terms of aggregate hospital costs, it represents the single-most expensive operative procedure, accounting for $12.8 billion per year. 3 This large aggregate expense, along with the trend of increased utilization, 4 has made spine surgery a leading target for cost containment. 5,6 A fundamental problem in spine management is that much of the pre-clinical research and in-vitro testing of surgical instrumentation and devices, which has led to approval of a staggering number of operative choices, has not necessarily produced improved patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Advanced Multi-Axis Spine Testing: Clinical Relevance and Research Recommendations

et al. 2015

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Back pain and spinal degeneration affect a large proportion of the general population. The economic burden of spinal degeneration is significant, and the treatment of spinal degeneration represents a large proportion of healthcare costs. However, spinal surgery does not always provide improved clinical outcomes compared to non-surgical alternatives, and modern interventions, such as total disc replacement, may not offer clinically relevant improvements over more established procedures. Although psychological and socioeconomic factors play an important role in the development and response to back pain, the variation in clinical success is also related to the complexity of the spine, and the multi-faceted manner by which spinal degeneration often occurs.The successful surgical treatment of degenerative spinal conditions requires collaboration between surgeons, engineers, and scientists in order to provide a multi-disciplinary approach to managing the complete condition. In this review, we provide relevant background from both the clinical and the basic research perspectives, which is synthesized into several examples and recommendations for consideration in increasing translational research between communities with the goal of providing improved knowledge and care.Current clinical imaging, and multi-axis testing machines, offer great promise for future research by combining invivo kinematics and loading with in-vitro testing in six degrees of freedom to offer more accurate predictions of the performance of new spinal instrumentation. Upon synthesis of the literature, it is recommended that in-vitro tests strive to recreate as many aspects of the in-vivo environment as possible, and that a physiological preload is a critical factor in assessing spinal biomechanics in the laboratory. A greater link between surgical procedures, and the outcomes in all three anatomical planes should be considered in both the in-vivo and in-vitro settings, to provide data relevant to quality of motion, and stability.

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“…American guidelines consider both decompression alone and decompression with concomitant fusion as effective for the treatment of lumbar stenosis with concomitant stenosis. However, decompression with concomitant instrumented fusion is still common practice [37,38]. With this review, demonstrating that decompression and decompression and fusion are equally effective in treating lumbar degenerative spondylolisthesis, especially regarding the ODI, being the most important clinical outcome measure, and leg pain, with higher costs and presumably higher complications rates associated with decompression with fusion, we hope to add to the discussion.…”

Section: Discussionmentioning

confidence: 92%

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

et al. 2018

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Purpose The primary objective of this systematic review is to compare the outcome after decompression with and without concomitant instrumented fusion in patients with lumbar stenosis and degenerative spondylolisthesis. Does adding fusion to simple decompression lead to better results? Methods PubMed, Embase, CENTRAL, Cochrane, Web of Science, CINAHL and Academic Search Premier were searched. All studies comparing outcome of decompression alone to decompression with concomitant-instrumented fusion in patients suffering from symptomatic lumbar stenosis with degenerative spondylolisthesis were included. Risk of bias was assessed using an adapted version of the Cowley checklist. Results Eleven studies were included in the analysis involving 3119 patients in total. In the majority of studies, including two RCTs, clinical outcome of both patient groups was comparable regarding most clinical outcome measures. Conclusion Currently there is not enough evidence that adding instrumented fusion to a decompression leads to superior outcomes compared to decompression only in patients with lumbar stenosis and degenerative spondylolisthesis. The most important clinical outcome measures, including the ODI, show comparable results. Therefore, the least invasive and least costly procedure, being decompression alone, is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Take Home Messages 1. Adding fusion to a decompression does not lead to better outcomes regarding the ODI and leg pain. Graphical abstract2. Decompression with concomitant fusion is presumably associated with more complications compared to decompression alone.3. Decompression alone is preferred in patients with low-grade spondylolisthesis with predominant leg pain. Forsth, P., et al. (2013). Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: A two-year follow-up study involving 5390 patients. Bone Joint J 95-B(7): 960-965 Forsth, P., et al. (2016). A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis.

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National Trends in the Use of Fusion Techniques to Treat Degenerative Spondylolisthesis

Abstract: 4.

Cited by 159 publications

References 18 publications

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

Natural hydroxyapatite as a bone graft extender for posterolateral spine arthrodesis

Advanced Multi-Axis Spine Testing: Clinical Relevance and Research Recommendations

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

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