To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis

Strube, Patrick; Putzier, Michael; Siewe, Jan; Eicker, Sven Oliver; Dreimann, Marc; Zippelius, Timo

doi:10.1007/s00402-018-3096-5

Cited by 10 publications

(9 citation statements)

References 32 publications

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“…Decision for one treatment over the other was based on the surgeons' experience, their perception of current evidence, the policy/routine at the institution, and sometimes on the patients' wishes. A survey among members of the Lumbar Spine Research Society and the AOSpine reported that patient-related factors such as higher age, absence of low back pain, and absence of instability at extensionflexion radiographs had the highest impact on the decision for performing decompression alone or not [177,178]. A similar survey from Germany found that the academic status of the hospital and speciality of the surgeon (orthopaedic surgery vs neurosurgery) in addition to patient age had the most impact on the decision to fuse or not [178].…”

Section: Allocation Bias -Propensity Score Matchingmentioning

confidence: 99%

“…A survey among members of the Lumbar Spine Research Society and the AOSpine reported that patient-related factors such as higher age, absence of low back pain, and absence of instability at extensionflexion radiographs had the highest impact on the decision for performing decompression alone or not [177,178]. A similar survey from Germany found that the academic status of the hospital and speciality of the surgeon (orthopaedic surgery vs neurosurgery) in addition to patient age had the most impact on the decision to fuse or not [178]. In papers I and III, allocation to treatment was most likely influenced by patient characteristics, clinical symptoms, and radiological findings.…”

Section: Allocation Bias -Propensity Score Matchingmentioning

confidence: 99%

See 1 more Smart Citation

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

et al. 2016

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Section: Allocation Bias -Propensity Score Matchingmentioning

confidence: 99%

Section: Allocation Bias -Propensity Score Matchingmentioning

confidence: 99%

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

et al. 2016

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“…Several studies of the variability of treatment preference for DLS have been conducted using clinical vignettes and survey responses from selected spine surgeons. 20,27,38 In a global survey of 223 responding members of the Lumbar Spine Research Society and AO Spine, Schroeder et al found that subspecialty, region of practice, and practice setting had no influence on surgeon treatment preference for DLS. 38 Rather, patient-specific factors such as the presence of mechanical back pain, radiographic instability, and age were most predictive of decompression only versus fusion.…”

Section: Discussionmentioning

confidence: 99%

“…17,20,21,[23][24][25] Previous studies of surgeon treatment preference for DLS were completed through online surveys of surgeon responses to clinical vignettes. 20,21,26,27 The NeuroPoint Alliance (NPA) Quality Outcomes Database (QOD), affiliated with the American Association of Neurological Surgeons, was established in 2012 and represents the largest prospectively and centrally maintained multiinstitutional clinical spine registry in North America with over 100 sites and 100,000 patients enrolled. 16,[28][29][30] Its primary purpose is to facilitate analysis of risk-adjusted morbidity and clinical outcomes of modern spine surgical procedures performed at high-volume centers.…”

mentioning

confidence: 99%

“…12,16,31 This registry is representative of real-world practice patterns and has the benefit of the continuous accumulation of data with contemporary and longitudinal sampling. 12,16,27,32 To that end, we report the QOD-derived comprehensive evaluation of patient-, surgeon-, and site-specific factors predictive of selecting decompression alone or with fusion in the treatment of patients with symptomatic DLS.…”

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confidence: 99%

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Impact of surgeon and hospital factors on surgical decision-making for grade 1 degenerative lumbar spondylolisthesis: a Quality Outcomes Database analysis

Huang

Buchholz

Goyal

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVESurgical treatment for degenerative spondylolisthesis has been proven to be clinically challenging and cost-effective. However, there is a range of thresholds that surgeons utilize for incorporating fusion in addition to decompressive laminectomy in these cases. This study investigates these surgeon- and site-specific factors by using the Quality Outcomes Database (QOD).METHODSThe QOD was queried for all cases that had undergone surgery for grade 1 spondylolisthesis from database inception to February 2019. In addition to patient-specific covariates, surgeon-specific covariates included age, sex, race, years in practice (0–10, 11–20, 21–30, > 30 years), and fellowship training. Site-specific variables included hospital location (rural, suburban, urban), teaching versus nonteaching status, and hospital type (government, nonfederal; private, nonprofit; private, investor owned). Multivariable regression and predictor importance analyses were performed to identify predictors of the treatment performed (decompression alone vs decompression and fusion). The model was clustered by site to account for site-specific heterogeneity in treatment selection.RESULTSA total of 12,322 cases were included with 1988 (16.1%) that had undergone decompression alone. On multivariable regression analysis clustered by site, adjusting for patient-level clinical covariates, no surgeon-specific factors were found to be significantly associated with the odds of selecting decompression alone as the surgery performed. However, sites located in suburban areas (OR 2.32, 95% CI 1.09–4.84, p = 0.03) were more likely to perform decompression alone (reference = urban). Sites located in rural areas had higher odds of performing decompression alone than hospitals located in urban areas, although the results were not statistically significant (OR 1.33, 95% CI 0.59–2.61, p = 0.49). Nonteaching status was independently associated with lower odds of performing decompression alone (OR 0.40, 95% CI 0.19–0.97, p = 0.04). Predictor importance analysis revealed that the most important determinants of treatment selection were dominant symptom (Wald χ2 = 34.7, accounting for 13.6% of total χ2) and concurrent diagnosis of disc herniation (Wald χ2 = 31.7, accounting for 12.4% of total χ2). Hospital teaching status was also found to be relatively important (Wald χ2 = 4.2, accounting for 1.6% of total χ2) but less important than other patient-level predictors.CONCLUSIONSNonteaching centers were more likely to perform decompressive laminectomy with supplemental fusion for spondylolisthesis. Suburban hospitals were more likely to perform decompression only. Surgeon characteristics were not found to influence treatment selection after adjustment for clinical covariates. Further large database registry experience from surgeons at high-volume academic centers at which surgically and medically complex patients are treated may provide additional insight into factors associated with treatment preference for degenerative spondylolisthesis.

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Minimally invasive fusion surgery for patients with degenerative spondylolisthesis and severe lumbar spinal stenosis: a comparative study between MIDLIF and TLIF

et al. 2023

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Purpose This study aims to compare midline lumbar interbody fusion (MIDLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for treatment of patients with severe stenosis and lumbar degenerative spondylolisthesis (DS), focusing on dural tears rates, other complications, clinical and radiological outcomes. Methods This cohort study included patients with severe lumbar spinal stenosis (Shizas C or D) and lumbar DS who underwent MIDLIF or MIS-TLIF. Propensity score matching was done and the groups were compared regarding surgery time, length of stay, perioperative complications, clinical results and radiological outcomes, at 1 year of follow-up. Results The study included initially 80 patients, and 72 patients after matching, 36 in each group. Six patients had dural tears, four in the MIDLIF group and two in the MIS-TLIF group (p = 0.67). General complication rates and reoperations were not significantly different between the groups. Good or excellent clinical was achieved in 75% of the MIDLIF patients and 72% of the MIS-TLIF patients (p = 0.91). Radiological parameters showed small but statistically significant (p < 0.01) improvements after surgery, particularly in segmental lordosis and lumbar lordosis (2.0° and 1.7°), while pelvic tilt and global tilt decreased (1.6° and 2.6°). These findings were similar for both groups. Conclusion Our study confirms that MIDLIF is a safe and reliable minimally invasive alternative for lumbar interbody fusion in DS, even in patients with severe stenosis and previous spine surgery. It seems to offer similar results to MIS-TLIF regarding clinical results, radiological outcomes and complications.

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To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis

Cited by 10 publications

References 32 publications

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

The effectiveness of decompression alone compared with additional fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a pragmatic comparative non-inferiority observational study from the Norwegian Registry for Spine Surgery

Impact of surgeon and hospital factors on surgical decision-making for grade 1 degenerative lumbar spondylolisthesis: a Quality Outcomes Database analysis

Minimally invasive fusion surgery for patients with degenerative spondylolisthesis and severe lumbar spinal stenosis: a comparative study between MIDLIF and TLIF

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