The Surgical Management of Degenerative Lumbar Spondylolisthesis

Martin, Candelaria; Gruszczynski, Adam T; Braunsfurth, Heike A; Fallatah, Salah; O’Neil, Joseph T.; Wai, Eugene K.

doi:10.1097/brs.0b013e3180bc219e

Cited by 226 publications

(144 citation statements)

References 19 publications

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“…None of the studies were able to find a significant difference, probably since the incidence of complications was too low to detect a statistically significant difference. Older studies that were not included in this review showed higher complication rates in the fusion group [9,31], with a more recent study by Deyo et al [17] clearly showing significant higher complications rates in the decompression and fusion group compared to the decompression alone group. After adjusting for age, comorbidities and other factors, there was a higher risk of life-threatening life-events for patients receiving decompression with concomitant fusion.…”

Section: Discussionmentioning

confidence: 64%

“…However, the optimal surgical treatment in patients suffering from symptomatic lumbar stenosis, who also have degenerative spondylolisthesis, has long been a subject of debate. Decompression without fusion for lumbar stenosis in the presence of degenerative spondylolisthesis has been associated with postoperative instability of the spine [5][6][7][8][9][10]. This postoperative instability is presumed to be the result of the removal of the posterior elements, such as the spinous process, inter-and supraspinous ligaments and medial aspect of the facet joints.…”

Section: Introductionmentioning

confidence: 99%

“…This postoperative instability is presumed to be the result of the removal of the posterior elements, such as the spinous process, inter-and supraspinous ligaments and medial aspect of the facet joints. Therefore, concomitant instrumented fusion may result in better postoperative clinical and functional outcomes [5,9,11]. Furthermore, concomitant instrumented fusion may be beneficial in cases of lumbar stenosis presenting with predominant symptoms of low back pain [12].…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…This practice is not supported through scientific data, while evidence supporting fusion in degenerative spondylolisthesis (slip of two adjacent vertebra), intuitively associated with progressive postsurgical spinal ''instability'', is lacking as well [28,29]. Besides the paucity of data reporting a clear beneficial effect of instrumented fusion, these ''advanced'' techniques are associated with an almost threefold risk of life-threatening complications.…”

Section: Decompression Versus Decompression With Instrumented Fusionmentioning

confidence: 99%

Minimally invasive surgery for lumbar spinal stenosis

Moojen

Gaag

2016

Eur J Orthop Surg Traumatol

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Recent trends in spine surgery, such as endoscopic and other ''micro'' techniques, promise less invasive procedures with better outcomes compared to conventional open techniques for decompressing nerves. Minimally invasive surgery (MIS), highly promoted by commercial parties for instrumented cases in particular, is popular with patients and physicians [1]. Widespread adoption of these techniques should always be preceded by careful evaluation to ensure safety and determine added value of such so-called surgical innovation [2,3]. Actual and controversial topics concerning MIS for lumbar spinal stenosis (LSS) were recently addressed in high-quality studies: open laminectomy versus microdecompression by Nerland et al. and decompression versus interspinous process implant by our group [4,5]. In some way, the opposite of MIS was addressed in a recent landmark study by Försth et al.; does decompression versus decompression plus instrumented fusion for LSS yield better outcomes [6]? The three studies address very relevant issues of the neurosurgical daily practice and will be discussed hereafter. The authors analyze data from a large, well-maintained and comprehensive national registry in Norway (the Norwegian Registry for Spine Surgery, NORspine). Thirty six out of 40 centers performing lumbar spine surgery in Norway record data prospectively in NORspine, making it a one of the unique national resource for spine research. Nerland and colleagues identified 885 eligible patients (out of 2745 screened) of whom 81 % completed the 1-year follow-up. Open laminectomy versus microdecompressionOpen laminectomy and microdecompression were associated with similar and statistically equivalent improvements in Oswestry disability scores and quality of life (EuroQol EQ-5D) at 1-year follow-up. Furthermore, the techniques did not differ in older people and obese patients in predefined subgroup analyses. The number of patients with complications was higher in the open laminectomy group (15.0 vs. 9.8 %, P = 0.018), but this difference did not hold after propensity matching (P = 0.23). Patients in the microdecompression group had shorter hospital stays, both for single-level decompression (difference 1.5 days, 95 % confidence interval 1.7-2.6, P \ 0.001) and two-level decompression (0.8 days, 1.0-2.2, P = 0.003).The authors concluded that microdecompression is the treatment of choice for patients with stenosis of the lumbar spine for the technique shows good clinical results, equal to open laminectomy at 1-year follow-up. Theoretically,

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“…Furthermore, there are different subtypes of LSS, but little is known about what characterizes these subtypes in terms of pain, function and HRQoL. The effect of a concomitant spinal fusion in LSS surgery is debated since data is conflicting (Herkowitz and Kurz 1991;Bridwell et al 1993;Mardjetko et al 1994;Grob et al 1995;Katz et al 1997;Ghogawala et al 2004;Matsudaira et al 2005;Martin et al 2007;Försth et al 2013).…”

Section: The Current Situationmentioning

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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The Surgical Management of Degenerative Lumbar Spondylolisthesis

Abstract: Spinal fusion may lead to a better clinical outcome than decompression alone. No conclusion about the clinical benefit of instrumenting a spinal fusion could be made. However, there is moderate evidence that the use of instrumentation improves the chance of achieving solid fusion.

Cited by 226 publications

References 19 publications

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

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

Minimally invasive surgery for lumbar spinal stenosis

Determinants of outcome in lumbar spinal stenosis surgery

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