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Van Ngoc Ty C, Fitton I, Arvieu R, Ferrero E, Garreau de Loubresse C, Khalifé M. Optimization of radiation doses for open lumbar spinal fusion using C-arm fluoroscopy and impact on radiation-induced cancer: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2043-2048. [PMID: 38565683 DOI: 10.1007/s00586-024-08236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/11/2024] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Intraoperative fluoroscopy use is essential during spinal fusion procedures. The amount of radiation dose should always be minimized. This study aimed to determine the feasibility of halving the frame rate from 12.5 to 6.25 frames per second (fps) and to quantify the reduction in the risk of developing radiation-induced cancer. METHODS This pilot study included 34 consecutive patients operated for open lumbar posterolateral fusion (PLF) with or without transforaminal lumbar interbody fusion (TLIF). C-arm modes were changed from half-dose (12.5 frames per second (fps), group I) to quarter-dose (6.25 fps, group II). Age, body mass index, surgical procedure, number of treated levels, and complications were collected. Kerma area product (KAP), cumulative air kerma (CAK), and fluoroscopy time were compared. Effective dose and radiation-induced cancer risk were estimated. RESULTS Eighteen and 16 patients were, respectively, included in group I and II. Demographic, surgical data, and fluoroscopy time were similar in both groups. However, CAK, KAP, and effective dose were significantly lower in group II, respectively, 0.56 versus 0.41 mGy (p = 0.03), 0.09 versus 0.06 Gy cm2 (p = 0.04), and 0.03 versus 0.02 mSv (p = 0.04). Radiation-induced cancer risk decreased by 47.7% from 1.49 × 10-6 to 7.77 × 10-7 after optimization. No complications were recorded in either group. CONCLUSION This study demonstrates the feasibility of setting 6.25 fps for TLIF with and without PLF. By halving the fps, radiation-induced cancer risk could be almost divided by two, without compromising surgical outcome. Finally, after optimization, the risk of developing radiation-induced cancer was less than one in a million.
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Affiliation(s)
- Claire Van Ngoc Ty
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France.
| | - Isabelle Fitton
- Department of Radiology, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France
| | - Robin Arvieu
- Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France
- Institut du Rachis, 59 rue Geoffroy Saint-Hilaire, 75005, Paris, France
| | - Emmanuelle Ferrero
- Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France
| | - Christian Garreau de Loubresse
- Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France
| | - Marc Khalifé
- Department of Orthopaedic, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Université de Paris Cité, 20 rue Leblanc, 75015, Paris, France
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Wu Y, Shen R, Li S, Luo T, Rong L, Zhang L. Fusion Surgery for Lumbar Spondylolisthesis: A Systematic Review with Network Meta-Analysis of Randomized Controlled Trials. World Neurosurg 2024; 185:327-337.e1. [PMID: 38369106 DOI: 10.1016/j.wneu.2024.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 02/09/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE This study aimed to systematically evaluate the optimal surgical fusion approach for lumbar spondylolisthesis, to provide the latest and most reliable evidence for future clinical practice. METHODS A comprehensive search of the PubMed, Ovid-Embase, Web of Science, Cochrane, and Scopus databases was conducted from inception to September 1, 2023, to identify relevant records. Two independent reviewers performed the literature screening, data extraction, and assessment of study quality. RESULTS Fifteen randomized controlled trials involving 892 patients met the inclusion criteria. The network evidence plot showed that posterolateral fusion and posterior lumbar interbody fusion (PLIF) were the most used fusion techniques. The network meta-analysis results revealed that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) had a significantly greater improvement in the Oswestry Disability Index (ODI) compared to endoscopic-TLIF, while PLIF had a significantly better fusion effect than posterolateral fusion. Furthermore, no statistically significant differences were observed between other fusion surgeries in terms of improving ODI, fusion rate, complications, or the improvement of visual analog scale-low back pain. The surface under the cumulative ranking curve results indicated that MIS-TLIF had the greatest potential for improving ODI, visual analog scale-low back pain, and complications, while PLIF had the greatest potential for increasing fusion rates. However, the existing selection bias, measurement bias, reporting bias, and publication bias may have reduced the reliability of the meta-analysis results. CONCLUSIONS Among the various fusion surgeries for lumbar spondylolisthesis, MIS-TLIF appears to provide the greatest benefit to patients. However, more high-quality, large-scale studies are needed to further investigate the treatment efficacy of different fusion surgeries for lumbar spondylolisthesis.
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Affiliation(s)
- Yingjie Wu
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Ruoqi Shen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Shengke Li
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Ting Luo
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Liangming Zhang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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Sobański D, Bogdał P, Staszkiewicz R, Sobańska M, Filipowicz M, Czepko RA, Strojny D, Grabarek BO. Evaluation of differences in expression pattern of three isoforms of the transforming growth factor beta in patients with lumbosacral stenosis. Cell Cycle 2024; 23:555-572. [PMID: 38695374 PMCID: PMC11135850 DOI: 10.1080/15384101.2024.2345484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/30/2024] [Indexed: 05/28/2024] Open
Abstract
The study investigates molecular changes in the lumbosacral (L/S) spine's yellow ligamentum flavum during degenerative stenosis, focusing on the role of transforming growth factor beta 1-3 (TGF-β-1-3). Sixty patients with degenerative stenosis and sixty control participants underwent molecular analysis using real-time quantitative reverse transcription reaction technique (RTqPCR), enzyme-linked immunosorbent assay (ELISA), Western blot, and immunohistochemical analysis (IHC). At the mRNA level, study samples showed reduced expression of TGF-β-1 and TGF-β-3, while TGF-β-2 increased by only 4%. Conversely, at the protein level, the study group exhibited significantly higher concentrations of TGF-β-1, TGF-β-2, and TGF-β-3 compared to controls. On the other hand, at the protein level, a statistically significant higher concentration of TGF-β-1 was observed (2139.33 pg/mL ± 2593.72 pg/mL vs. 252.45 pg/mL ± 83.89 pg/mL; p < 0.0001), TGF-β-2 (3104.34 pg/mL ± 1192.74 pg/mL vs. 258.86 pg/mL ± 82.98 pg/mL; p < 0.0001), TGF-β-3 (512.75 pg/mL ± 107.36 pg/mL vs. 55.06 pg/mL ± 9.83 pg/mL, p < 0.0001) in yellow ligaments obtained from patients of the study group compared to control samples. The study did not establish a significant correlation between TGF-β-1-3 concentrations and pain severity. The findings suggest that molecular therapy aimed at restoring the normal expression pattern of TGF-β-1-3 could be a promising strategy for treating degenerative stenosis of the L/S spine. The study underscores the potential therapeutic significance of addressing molecular changes at the TGF-β isoforms level for better understanding and managing degenerative spinal conditions.
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Affiliation(s)
- Dawid Sobański
- Department of Neurosurgery, Szpital sw. Rafala in Cracow, Cracow, Poland
- Collegium Medicum, WSB University, Dabrowa Gornicza, Poland
| | - Paweł Bogdał
- Department of Orthopedic, Szpital Powiatowy w Zawierciu, Zawiercie, Poland
| | - Rafał Staszkiewicz
- Collegium Medicum, WSB University, Dabrowa Gornicza, Poland
- Department of Neurosurgery, 5th Military Clinical Hospital with the SP ZOZ Polyclinic in Krakow, Krakow, Poland
- Department of Neurosurgery, Faculty of Medicine in Zabrze, Academy of Silesia, Katowice, Poland
| | | | - Michał Filipowicz
- Department of Neurosurgery, Szpital sw. Rafala in Cracow, Cracow, Poland
| | - Ryszard Adam Czepko
- Department of Neurosurgery, Szpital sw. Rafala in Cracow, Cracow, Poland
- Department of Neurosurgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski University in Cracow, Cracow, Poland
| | - Damian Strojny
- Collegium Medicum, WSB University, Dabrowa Gornicza, Poland
- Institute of Health Care, National Academy of Applied Sciences in Przemyśl, Przemyśl, Poland
- Department of Medical Science, New Medical Techniques Specialist Hospital of St. Family in Rudna Mała, Rzeszów, Poland
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Baltic SP, Lyons KW, Mariaux F, Mannion AF, Werth PM, Fekete T, Porchet F, Kepler C, McGuire KJ, Lurie JD, Pearson AM. Evaluation of the Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system as a guide to surgical technique selection. Spine J 2023; 23:1641-1651. [PMID: 37406861 DOI: 10.1016/j.spinee.2023.06.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND CONTEXT The role of fusion in degenerative spondylolisthesis (DS) is controversial. The Clinical and Radiographic Degenerative Spondylolisthesis (CARDS) classification system was developed to assist surgeons in surgical technique selection based on individual patient characteristics. This system has not been clinically validated as a guide to surgical technique selection. PURPOSE The purpose of this study was to determine if outcomes vary with different surgical techniques across the CARDS categories. STUDY DESIGN/SETTING Prospective cohort study performed at one Swiss and one American spine center. PATIENT SAMPLE Five hundred eight patients with DS undergoing surgical treatment. OUTCOME MEASURES Core Outcomes Measure Index (COMI) at 3 months and 12 months postoperatively. METHODS Patients undergoing surgery for DS were enrolled at 2 institutions and classified according to the CARDS system using dynamic radiographs. The Core Outcome Measure Index (COMI) was completed preoperatively, and 3 and 12 months postoperatively. Surgical technique was classified as uninstrumented (decompression alone or decompression with uninstrumented fusion) or instrumented (decompression with pedicle screw instrumentation with or without interbody fusion). Unadjusted analyses and mixed effect models compared COMI scores between the two surgery technique groups (uninstrumented vs instrumented), stratified by CARDS category over time. Reoperation rates were also compared between the surgery technique groups stratified by CARDS category. Partial funding was given through NASS grant for clinical research. RESULTS Five hundred five out of 508 patients enrolled in the study had sufficient data to be classified according to CARDS. Seven percent were classified as CARDS A, 28% as CARDS B, 48% as CARDS C, and 17% as CARDS D (CARDS A most "stable," CARDS D least "stable"). One hundred and thirty-three patients (26%) underwent decompression alone, 30 (6%) underwent decompression and uninstrumented fusion, 42 (8%) underwent decompression and posterolateral instrumented fusion, and 303 (60%) underwent decompression with posterolateral and interbody instrumented fusion. Patients in the least "stable" categories tended to be less likely to be treated with an uninstrumented technique (CARDS D 19% vs 32% for the other categories, p=.10). There were no significant differences in 3 or 12-month COMI scores between surgical technique groups stratified by CARDS category in the unadjusted or adjusted analyses. In the unadjusted analyses, there was a trend towards less improvement in 12-month COMI change score in the CARDS D patients in the uninstrumented group compared to the instrumented group (-2.7 vs -4.1, p=.10). Reoperation rates were not significantly different between the surgical technique groups stratified by CARDS category. CONCLUSIONS In general, outcomes for uninstrumented and instrumented surgical techniques were similar across the CARDS categories. Surgeons likely took factors included in CARDS into account during surgical technique selection. This resulted in a low number of CARDS D (n=15) patients being treated with uninstrumented techniques, which limited the statistical power of this analysis. As such, this study does not validate CARDS as a useful classification system for surgical technique selection in DS.
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Affiliation(s)
- Steven P Baltic
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Keith W Lyons
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Francine Mariaux
- Department of Teaching, Research and Development, Spine Division, Schulthess Klinik, Lengghalde 2, Zurich 8008, CH, Switzerland
| | - Anne F Mannion
- Department of Teaching, Research and Development, Spine Division, Schulthess Klinik, Lengghalde 2, Zurich 8008, CH, Switzerland
| | - Paul M Werth
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Tamas Fekete
- Department of Teaching, Research and Development, Spine Division, Schulthess Klinik, Lengghalde 2, Zurich 8008, CH, Switzerland
| | - Francois Porchet
- Department of Teaching, Research and Development, Spine Division, Schulthess Klinik, Lengghalde 2, Zurich 8008, CH, Switzerland
| | - Christopher Kepler
- Orthopaedics, Thomas Jefferson University, 833 Chestnut St, Suite 1402, Philadelphia, PA 19107, USA
| | - Kevin J McGuire
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Jon D Lurie
- Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA
| | - Adam M Pearson
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr, Lebanon, NH 03756, USA.
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van Grafhorst JMP, Dijkerman ML, Peul WC, Vleggeert-Lankamp CLA. Symptomatic lumbar stenosis due to low-grade degenerative spondylolisthesis can effectively be treated with mere decompression. Acta Neurochir (Wien) 2023; 165:2145-2151. [PMID: 37410183 PMCID: PMC10409655 DOI: 10.1007/s00701-023-05667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/31/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Adding instrumented spondylodesis to decompression in symptomatic spinal stenosis with degenerative spondylolisthesis is subject of debate. The presence of spondylolisthesis due to degeneration is an indicator of severe facet joint and intervertebral disc degeneration, and this may fit increased instability of the spine. We aim to establish the incidence of degenerative spondylolisthesis in spinal stenosis surgical candidates and to evaluate the incidence of failure of decompressive surgery without concomitant spondylodesis as initial treatment. METHODS Medical files of all operated patients for spinal stenosis between 2007 and 2013 were evaluated. Demographic characteristics, pre-operative radiological characteristics (level of stenosis, presence, and grade of spondylolisthesis), surgical technique, incidence, and indication for reoperation were summarised, as well as the type of reoperation. Patient satisfaction was classified as 'satisfied' or 'unsatisfied' after initial and secondary surgery. The follow-up was 6 to 12 years. RESULTS Nine hundred thirty-four patients were included, and 253 (27%) had a spondylolisthesis. Seventeen percent of the spondylolisthesis patients receiving decompression were reoperated versus 12% of the stenosis patients (p=.059). Reoperation in the spondylolisthesis group concerned instrumented spondylodesis in 38 versus 10% in the stenosis group. The satisfaction percentage was comparable in the stenosis and the spondylolisthesis group two months after surgery (80 vs. 74%). Of the 253 spondylolisthesis patients, 1% initially received instrumented spondylodesis and 6% in a second operation. CONCLUSION Lumbar stenosis with and without (low-grade) degenerative spondylolisthesis can usually effectively be treated with mere decompression. Instrumented surgery in a second surgical procedure does not lead to less satisfaction with surgical outcomes.
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Affiliation(s)
| | - Manon L Dijkerman
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
| | - Carmen L A Vleggeert-Lankamp
- University Neurosurgical Center Holland, LUMC, HMC, HAGA, Leiden, the Netherlands
- Department of Neurosurgery, Spaarne Gasthuis, Haarlem/Hoofddorp, Netherlands
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Shukla GG, Chilakapati SS, Matur AV, Palmisciano P, Conteh F, Onyewadume L, Duah H, Griffith A, Tao X, Vorster P, Gupta S, Cheng J, Motley B, Adogwa O. Laminectomy With Fusion is Associated With Greater Functional Improvement Compared With Laminectomy Alone for the Treatment of Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2023; 48:874-884. [PMID: 37026781 DOI: 10.1097/brs.0000000000004673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/17/2023] [Indexed: 04/08/2023]
Abstract
STUDY DESIGN Systematic review and Meta-analysis. OBJECTIVE To compare outcomes and complications profile of laminectomy alone versus laminectomy and fusion for the treatment of degenerative lumbar spondylolisthesis (DLS). SUMMARY OF BACKGROUND DATA Degenerative lumbar spondylolisthesis is a common cause of back pain and functional impairment. DLS is associated with high monetary (up to $100 billion annually in the US) and nonmonetary societal and personal costs. While nonoperative management remains the first-line treatment for DLS, decompressive laminectomy with or without fusion is indicated for the treatment-resistant disease. METHODS We systematically searched PubMed and EMBASE for RCTs and cohort studies from inception through April 14, 2022. Data were pooled using random-effects meta-analysis. The risk of bias was assessed using the Joanna Briggs Institute risk of bias tool. We generated odds ratio and standard mean difference estimates for select parameters. RESULTS A total of 23 manuscripts were included (n=90,996 patients). Complication rates were higher in patients undergoing laminectomy and fusion compared with laminectomy alone (OR: 1.55, P <0.001). Rates of reoperation were similar between both groups (OR: 0.67, P =0.10). Laminectomy with fusion was associated with a longer duration of surgery (Standard Mean Difference: 2.60, P =0.04) and a longer hospital stay (2.16, P =0.01). Compared with laminectomy alone, the extent of functional improvement in pain and disability was superior in the laminectomy and fusion cohort. Laminectomy with fusion had a greater mean change in ODI (-0.38, P <0.01) compared with laminectomy alone. Laminectomy with fusion was associated with a greater mean change in NRS leg score (-0.11, P =0.04) and NRS back score (-0.45, P <0.01). CONCLUSION Compared with laminectomy alone, laminectomy with fusion is associated with greater postoperative improvement in pain and disability, albeit with a longer duration of surgery and hospital stay.
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Affiliation(s)
- Geet G Shukla
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Abhijith V Matur
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Paolo Palmisciano
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Fatu Conteh
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louisa Onyewadume
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Henry Duah
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Azante Griffith
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Xu Tao
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Phillip Vorster
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sahil Gupta
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Benjamin Motley
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
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Yeditepe spine mesh: Finite element modeling and validation of a parametric CAD model of lumbar spine. Med Eng Phys 2022; 110:103911. [PMID: 36564136 DOI: 10.1016/j.medengphy.2022.103911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/21/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
Finite element analysis is a powerful tool that is often used to study the biomechanical response of the spine. The primary objective of this study was to illustrate the mechanical behavior of a previously proposed parametric CAD spine model in comparison with a segmented FSU model and the literature. In this study, two finite element models of the L4-L5 spinal level were developed from the same patient's CT scan data. The first was developed using well-known segmentation methods, whereas the second was developed from the new by using a novel parametric CAD model. Both models were subjected to the same loading and boundary conditions to perform flexion, extension, lateral bending and axial rotation motions. The segmented finite element model was observed to be in good agreement with the literature. The parametric finite element model results were also observed to be in good agreement with the segmented finite element model and with the literature except under extension.
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Tozawa K, Matsubayashi Y, Kato S, Doi T, Taniguchi Y, Kumanomido Y, Higashikawa A, Yosihida Y, Kawamura N, Sasaki K, Azuma S, Yu J, Hara N, Iizuka M, Ono T, Fukushima M, Takeshita Y, Tanaka S, Oshima Y. Surgical outcomes between posterior decompression alone and posterior decompression with fusion surgery among patients with Meyerding grade 2 degenerative spondylolisthesis: a multicenter cohort study. BMC Musculoskelet Disord 2022; 23:902. [PMID: 36209211 PMCID: PMC9548127 DOI: 10.1186/s12891-022-05850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/17/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Whether lumbar decompression with fusion surgery is effective against Meyerding grade 2 degenerative spondylolisthesis (DS) is unknown. Therefore, the current study aimed to compare the surgical outcomes between posterior decompression alone and posterior decompression with fusion surgery among patients with grade 2 DS with central canal stenosis. Methods This retrospective cohort study included prospectively registered patients (n = 3863) who underwent surgery for degenerative lumbar spinal canal stenosis at nine high-volume spine centers from April 2017 to July 2019. Patients with grade 2 DS and central canal stenosis were included in the analysis. Patients with radiculopathy, including foraminal stenosis, degenerative scoliosis, and concomitant anterior spinal fusion, and those with a previous history of lumbar surgery were excluded. The participants were divided into the decompression alone group (group D) and decompression with fusion surgery group (group F). Data about patient-reported outcomes, including Numeric Rating Scale (low back pain, leg pain, leg numbness, and foot numbness), Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 2 years postoperatively. Results In total, 2354 (61%) patients, including 42 (1.8%) with grade 2 DS (n = 18 in group D and n = 24 in group F), completed the 2-year follow-up. Group D had a higher proportion of female patients than group F. However, the two groups did not significantly differ in terms of other baseline demographic characteristics. Group D had a significantly shorter surgical time and lower volume of intraoperative blood loss than group F. Postoperative patient-reported outcomes did not significantly differ between the two groups, although the preoperative degree of low back pain was higher in group F than in group D. The slip degree of group D did not worsen during the follow-up period. Conclusion The surgical outcomes were similar regardless of the addition of fusion surgery among patients with grade 2 DS. Decompression alone was superior to decompression with fusion surgery as it was associated with a lower volume of intraoperative blood loss and shorter surgical time.
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Affiliation(s)
- Keiichiro Tozawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - Yudai Kumanomido
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, 211-8510, Kawasaki City, Kanagawa, Japan
| | - Akiro Higashikawa
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, 1-1, Kizukisumiyoshi-Cho, Nakahaha-Ku, 211-8510, Kawasaki City, Kanagawa, Japan
| | - Yuichi Yosihida
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya- Ku, 150-8935, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-2, Hiroo, Shibuya- Ku, 150-8935, Tokyo, Japan
| | - Katsuyuki Sasaki
- Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, 1-5, Shintoshin, Chuo-Ku, 330-8553, Saitama City, Saitama, Japan
| | - Seiichi Azuma
- Department of Orthopaedic Surgery, Japanese Red Cross Saitama Hospital, 1-5, Shintoshin, Chuo-Ku, 330-8553, Saitama City, Saitama, Japan
| | - Jim Yu
- Department of Orthopaedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1, 180-0023, Kyonancho, Musashino City, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopaedic Surgery, Japanese Red Cross Musashino Hospital, 1-26-1, 180-0023, Kyonancho, Musashino City, Tokyo, Japan
| | - Masaaki Iizuka
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, 162-8543, Tokyo, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-care Organization Tokyo Shinjuku Medical Center, 5-1, Tsukudo-Cho, Shinjuku-Ku, 162-8543, Tokyo, Japan
| | - Masayoshi Fukushima
- Spine Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, 105-8470, Tokyo, Japan
| | - Yujiro Takeshita
- Department of Orthopaedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, 3211, Kozukue-Cho, Kohoku-Ku, 222-0036, Yokohama City, Kanagawa, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, 113-8655, Tokyo, Japan.
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Musa G, Barrientos Castillo RE, Slabov MV, Chirwa K, Chmutin GE, Ramirez MDJE, Nurmukhametov R. Degenerative Grade 3 Spondylolisthesis Management: A Case Report and Literature Review. Cureus 2022; 14:e29374. [PMID: 36284806 PMCID: PMC9584580 DOI: 10.7759/cureus.29374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
Degenerative spine disorders are very common in the aging population. Degenerative spondylolisthesis is a relatively uncommon cause of chronic back pain in these patients. We present a case of high-grade spondylolisthesis managed with posterior lumbar interbody fusion (PLIF) and reduction of the listhesis with excellent results. A 56-year-old woman presented with chronic lower back pain managed as an outpatient for over 5 months with no relief. She had no history of trauma or risk factors for malignancy. Lumbosacral CT showed Meyerding grade 3 anterolisthesis of the fifth lumbar vertebra with complete L5-S1 disc collapse and bilateral spondylolysis. An MRI confirmed the findings. There was no spinal canal stenosis. The patient was managed with L4-L5-S1 transpedicular fixation and L5-S1 interbody cage with reduction of the listhesis. The patient had an incidental intraoperative dural tear which was repaired primarily and a wound drain was kept for 5 days without complications. The patient was ambulating by day 5 and was discharged without complications on day 10. Degenerative spondylolisthesis can cause chronic back pain with or without a history of trauma. Although no specific clinical features exist for this condition, it should be suspected in elderly patients even in the absence of a history of trauma. Surgical management in high-grade spondylolisthesis is indicated with interbody fixation and reduction.
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Wei FL, Zhou CP, Gao QY, Du MR, Gao HR, Zhu KL, Li T, Qian JX, Yan XD. Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis. EClinicalMedicine 2022; 51:101559. [PMID: 35865739 PMCID: PMC9294267 DOI: 10.1016/j.eclinm.2022.101559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Clinically, there are substantive practice variations in surgical management of degenerative lumbar spondylolisthesis. We aimed at evaluating whether decompression alone outcomes for patients with degenerative lumbar spondylolisthesis are comparable to those of decompression with fusion. METHODS In this meta-analysis, the Embase, PubMed, and Cochrane Library databases were searched from inception to February 16th, 2022. Randomised controlled trials (RCTs) and cohort studies comparing decompression alone with decompression and fusion for patients with degenerative lumbar spondylolisthesis were included in this study. There were no language limitations. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) were used to report results in the random-effects model. Main outcomes included Oswestry disability index (ODI), pain, clinical satisfaction, complication and reoperation rates. The study protocol was published in PROSPERO (CRD42022310645). FINDINGS Thirty-three studies (6 RCTs and 27 cohort studies) involving 94 953 participants were included. Differences in post-operative ODI between decompression alone and decompression with fusion were not significant. A small difference for back (MD, 0.13; [95% CI, 0.08 to 0.18]; I 2:0.00%) and leg pain (MD, 0.30; [95% CI, 0.09 to 0.51]; I 2:48.35%) was observed on the 3rd post-operative month. The results did not reveal significant differences in leg pain and back pain between decompression alone and fusion groups on the 6th, 12th, and 24th post-operative months. Difference in clinical satisfaction between decompression alone and decompression with fusion were not significant from RCTs (OR, 0.26; [95% CI, 0.03 to 1.92]; I 2:83.27%). Complications (OR, 1.54; [95% CI, 1.16 to 2.05]; I 2:48.88%), operation time (MD, 83.39; [95% CI, 55.93 to 110.85]; I 2:98.75%), intra-operative blood loss (MD, 264.58; [95% CI, 174.99 to 354.16]; I 2:95.61%) and length of hospital stay (MD, 2.85; [95% CI, 1.60 to 4.10]; I 2:99.49%) were higher with fusion. INTERPRETATION Clinical effectiveness of decompression alone was comparable to that of decompression with fusion for degenerative lumbar spondylolisthesis. Decompression alone is recommended for patients with degenerative lumbar spondylolisthesis. FUNDING This work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei), Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265) and Social Talent Fund of Tangdu Hospital (No.2021SHRC034).
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Quan-You Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, 710032, Xi'an, China
- Corresponding author at: School of Basic Medicine, Fourth Military Medical University, No. 169 Changle Rd, Xi'an 710032, China.
| | - Ji-Xian Qian
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
| | - Xiao-Dong Yan
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, 710038, Xi'an, China
- Corresponding author at: Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, China.
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11
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Arimbawa IBG, Pranata CGRA, Daniati S, Putra MWS, Savio SD, Wiguna IGLNAA, Ridia KGM, Suyasa IK. Comparison between Decompression Alone and with Additional Fusion for Degenerative Lumbar Spondylolisthesis: A Systematic Review and Meta-Analysis. Spine Surg Relat Res 2022; 7:42-51. [PMID: 36819637 PMCID: PMC9931411 DOI: 10.22603/ssrr.2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Degenerative lumbar spondylolisthesis affects approximately 10% of adults over 40. Although decompression has been the treatment of choice, some surgeons note possible instability development after decompression alone (D). Previous studies show that decompression with fusion (DF) has similar complication rates but is better at preventing slip progression and reducing pain. However, others stated the additional instrumentation does not result in superior functional outcomes and has higher costs and complication rates. This study aims to provide an objective, two-arm comparison of the two treatments using systematic review and meta-analysis. Methods The study design was a systematic review and meta-analysis of relevant randomized controlled trials and nonrandomized comparative studies. A systematic search was conducted from April 2021 to September 2021 to identify relevant studies using PubMed, Google Scholar, EMBASE, and Cochrane databases based on PRISMA guidelines. Results This systematic review included 8 studies (6,669 patients); 7 (6,569 patients) were included in the meta-analysis, with a follow-up period of up to 143 months. The most commonly affected level was L4-5, with females being more affected than males. Visual Analog Scale improvement on back pain was significantly better in DF group (Heterogeneity, I2=32%; WMD -0.72; 95% Confidence Interval (CI), -1.35 to -0.08; P=0.03), as well as postoperative back pain (I2=96%; WMD 0.87; 95% CI, 0.19 to 1.55; P=0.01). The leg pain, Oswestry Disability Index (ODI), satisfaction rate, complication rate, and revision rate were comparable between the two procedures. Conclusions Current systematic review and meta-analysis proved that DF is better than D in terms of back pain improvement, and the two procedures are comparable in terms of leg pain, ODI, satisfaction rate, complication rate, and revision rate.
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Affiliation(s)
- Ida Bagus Gede Arimbawa
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Cokorda Gde Rama Adi Pranata
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Sonia Daniati
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Made Winatra Satya Putra
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Sherly Desnita Savio
- Resident of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - I Gusti Lanang Ngurah Agung Artha Wiguna
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Ketut Gede Mulyadi Ridia
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - I Ketut Suyasa
- Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
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12
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Shen Z, Guan X, Wang R, Xue Q, Zhang D, Zong Y, Ma W, Zhuge R, Liu Z, He C, Guo L, Yin F. Effectiveness and safety of decompression alone versus decompression plus fusion for lumbar spinal stenosis with degenerative spondylolisthesis: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:664. [PMID: 35845482 PMCID: PMC9279815 DOI: 10.21037/atm-22-2208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/08/2022] [Indexed: 11/09/2022]
Abstract
Background There have been lingering controversies reported decompression and plus fusion. And the relative safety of fusion in addition to standard decompression remains unclear. This study aimed to assess the effectiveness and safety of decompression alone or combined with fusion in lumbar spinal stenosis (LSS) with degenerative spondylolisthesis (DS). Methods In this systematic review and meta-analysis, we searched the databases of PubMed, Embase, Cochrane Library, and Web of Science for relevant literature from their inception to 28th December 2021. We identified the eligible studies based on the PICOS principles, populations (LSS with DS), interventions (decompression alone), controls (decompression combined with fusion), outcomes [overall reoperation rate, complications, Oswestry Disability Index (ODI), operative time, the amount of blood lost, length of stay (LOS), and visual analog scales (VAS)], study design (cohort studies). Quality assessment for individual study was performed with the Newcastle-Ottawa Scale (NOS). Results In all, 12 articles involving a total of 14,693 patients were finally included in the study, the majority of patients underwent decompression alone (DA group: n=11,598) and the rest underwent decompression associated with fusion (FU group: n=3,095). The quality of most of the included studies was regarded as high quality. The results indicated that the FU group had a higher rate of complication [relative risk (RR): 1.770, 95% confidence interval (CI): 1.485 to 2.110], longer operative time [weighted mean difference (WMD): 51.037, 95% CI: 13.743 to 88.330], and increased blood loss (WMD: 258.354, 95% CI: 150.468 to 366.239) than the DA group (all P<0.05), with no significant differences for overall reoperation rate (RR: 0.879, 95% CI: 0.432 to 1.786), ODI (WMD: −2.569, 95% CI: −6.548 to 1.409), LOS (WMD: 3.838, 95% CI: −2.172 to 9.848), and VAS found between the two groups (P>0.05). Conclusions In patients with LSS + DS, the effectiveness and safety of decompression alone may be superior to decompression plus fusion in terms of complication rate, operative time, and the amount of bleeding. However, more high-quality literature is needed in the future to confirm the best treatment choice for patients with LSS + DS.
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Affiliation(s)
- Zhubin Shen
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaojing Guan
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Rui Wang
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Qian Xue
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Ding Zhang
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuan Zong
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Wenxuan Ma
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Ruijian Zhuge
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Zhiming Liu
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Changhao He
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Li Guo
- Department of Toxicology, School of Public Health of Jilin University, Changchun, China
| | - Fei Yin
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
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13
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Morse KW, Alluri RK, Vaishnav AS, Urakawa H, Mok JK, Virk SS, Sheha ED, Qureshi SA. Do preoperative clinical and radiographic characteristics impact patient outcomes following one-level minimally invasive transforaminal lumbar interbody fusion based upon presenting symptoms? Spine J 2022; 22:570-577. [PMID: 34699995 PMCID: PMC9178522 DOI: 10.1016/j.spinee.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients undergoing minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) frequently present with lower extremity neurologic symptoms with or without associated lower back pain. While symptomatic improvement of leg and back pain has been reported, the resolution of back pain when it is a predominant presenting symptom remains underreported following MI-TLIF. PURPOSE The purpose of this study was to compare clinical outcomes at 1 year of patients undergoing MI-TLIF with lower extremity neurologic symptoms with and without a significant component of back pain. STUDY DESIGN A retrospective review of prospectively collected data from a single surgeon surgical database from 2017 to 2019 was performed. PATIENT SAMPLE Fifty one patients undergoing MI-TLIF. OUTCOME MEASURES Self-reported measures included the Oswestry Disability Index (ODI), Visual analog scale back pain (VAS-back), and VAS leg pain (VAS-leg). METHODS Patients were divided into two groups: Leg Pain Predominant (patients reported greater than 50% leg pain upon presentation) and Back Pain Predominant (patients reported 50% or greater back pain). Multivariate analysis was performed to determine differences between groups based upon any significantly baseline characteristics. RESULTS Preoperative demographic and radiographic outcomes were similar between the two groups. Both groups demonstrated significant improvement in ODI, VAS-Back and VAS-leg at 1-year postoperatively. On multivariate analysis, there were differences in ODI at 1-year, 1-year back pain, and 1-year leg pain between groups with those who initially presented with leg pain having a lower ODI, VAS Back, and VAS leg. Patients who presented with predominantly leg pain were more likely to meet minimal clinically important difference (MCID) criteria for ODI and VAS-back compared to those with predominantly back pain. CONCLUSION Following MI-TLIF, patients with lower extremity neurologic symptoms with and without a significant component of back pain have improvements in back pain, leg pain, and ODI regardless of their primary presenting pain complaint; however, patients who presented with predominantly leg pain were more likely to meet MCID criteria for improvement in their back pain and ODI score.
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Affiliation(s)
- Kyle W. Morse
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Avani S. Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Hikari Urakawa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | | | - Sohrab S. Virk
- Department of Orthopaedic Surgery, North Shore Long Island Jewish Medical Center, New Hyde Park, NY
| | - Evan D. Sheha
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY
| | - Sheeraz A. Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Weill Cornell Medical College, New York, NY.,Corresponding author: Sheeraz A. Qureshi, MD MBA, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA, Phone: 212-606-1585, Fax: 917-260-3185,
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14
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Pranata R, Lim MA, Vania R, Bagus Mahadewa TG. Decompression Alone Compared to Decompression With Fusion in Patients With Lumbar Spondylolisthesis: Systematic Review, Meta-Analysis, and Meta-Regression. Int J Spine Surg 2022; 16:71-80. [PMID: 35314509 PMCID: PMC9519074 DOI: 10.14444/8179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND We aimed to synthesize the latest evidence on the efficacy and safety of decompression alone compared to decompression with fusion in patients with lumbar spondylolisthesis. We also aimed to evaluate factors affecting the efficacy and complications. METHODS A systematic literature search was conducted using PubMed, Scopus, Europe PMC, Cochrane Central Database, and ClinicalTrials.gov. The main outcome was improvement in Oswestry Disability Index (ODI). The secondary outcome was back pain and leg pain improvement, complications, reoperation rate, duration of surgery, length of hospital stay, and blood loss. RESULTS There were 3993 patients from 13 studies. Decompression with fusion was associated with greater reduction in ODI (mean difference 4.04 [95% CI 0.95, 7.13], P = 0.01) compared to decompression alone. Greater reduction in back (standardized mean difference [SMD] 0.27 [95% CI 0.00, 0.53], P = 0.05) and leg pain (SMD 0.13 [95% CI 0.06, 0.21], P < 0.001) was observed in the decompression with fusion group. Complications were similar in the 2 groups (OR 0.60 [95% CI 0.34, 1.04], P = 0.07). The reoperation rate was similar in both groups (P = 0.54). Decompression alone resulted in shorter duration of surgery (mean difference -85.18 minutes [95% CI -122.79, -47.57], P < 0.001), less blood loss (mean difference -262.65 mL [95% CI -313.45, -211.85], P < 0.001), and shorter hospital stay (mean difference -2.64 days [95% CI -3.58, -1.70], P < 0.001). Empirical Bayes random-effects meta-regression showed that the rate of complication was influenced by age (coefficient 0.172, P = 0.004). CONCLUSION Decompression with fusion had greater efficacy than decompression alone but was associated with more blood loss, lengthier surgery, and hospitalization. In terms of complications, decompression alone may be beneficial in younger patients. (PROSPERO CRD42020211904) LEVEL OF EVIDENCE: 2A.
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Affiliation(s)
- Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | | | - Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Tjokorda Gde Bagus Mahadewa
- Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
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15
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Goh GS, Yue WM, Guo CM, Tan SB, Chen JLT. Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction, and Return to Work After Minimally Invasive Transforaminal Lumbar Interbody Fusion For Degenerative Spondylolisthesis? Clin Spine Surg 2022; 35:E143-E149. [PMID: 34008509 DOI: 10.1097/bsd.0000000000001193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/07/2021] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The objective of this study was to determine how different combinations of preoperative back pain (BP) and leg pain (LP) may influence functional outcomes, patient satisfaction and return to work (RTW) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative spondylolisthesis. SUMMARY OF BACKGROUND DATA Surgical decision-making is often based on the traditional assumption that the predominance of lower extremity symptoms is a stronger indication for lumbar spine surgery. Surprisingly, there is a paucity of literature supporting this notion and the isolated impact of the preoperative pattern of pain on outcome remains unclear. METHODS Prospectively collected data for patients who underwent primary MIS-TLIF for degenerative spondylolisthesis were reviewed. Patients were categorized into 3 groups depending on predominant pain location: LP predominant (LP>BP), back pain predominant [(BPP); BP>LP] and equal pain predominance (BP=LP). Patients were prospectively followed for at least 2 years. RESULTS In total, 781 patients were included: 33.4% LP predominant, 28.7% BPP and 37.9% equal pain predominance cases. The BPP group was significantly younger (P=0.005) and showed a trend towards poorer baseline Short-Form-36 Mental Component Summary (P=0.069). After adjusting for baseline differences, there was no significant difference in BP, LP, Oswestry Disability Index (ODI), SF-36 Physical Component Summary, and SF-36 Mental Component Summary between the 3 groups at all time points (P>0.05) except for poorer 1-month ODI in the BPP group (P=0.010). The rate of minimal clinically important difference attainment for ODI and SF-36 Physical Component Summary, satisfaction, expectation fulfilment and RTW were also similar (P>0.05). CONCLUSIONS The functional outcomes, quality of life and satisfaction after MIS-TLIF were similar, regardless of the predominant pain location. Equal proportions of patients achieved the minimal clinically important difference and RTW. In the context of proper indications, these results suggest that MIS-TLIF can be equally effective for patients with varying combinations of BP or LP. LEVEL OF EVIDENCE Level III-nonrandomized cohort study.
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Affiliation(s)
- Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital
| | | | - Chang Ming Guo
- Department of Orthopedic Surgery, Singapore General Hospital
| | - Seang-Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore, Singapore
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16
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Goh GS, Yue WM, Guo CM, Tan SB, Chen JLT. Does the Predominant Pain Location Influence Functional Outcomes, Satisfaction and Return to Work After Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy? Spine (Phila Pa 1976) 2021; 46:E568-E575. [PMID: 33290363 DOI: 10.1097/brs.0000000000003855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively-collected registry data. OBJECTIVES The aim of this study was to determine how different combinations of preoperative neck pain (NP) and arm pain (AP) influence functional outcomes, patient satisfaction, and return-to-work in patients undergoing anterior cervical discectomy and fusion (ACDF) for degenerative cervical radiculopathy (DCR). SUMMARY OF BACKGROUND DATA Surgeons often base decisions on the traditional belief that the predominance of radicular upper extremity symptoms is a stronger indication for cervical spine surgery than axial pain. However, there is a paucity of literature supporting this notion. METHODS A prospectively maintained registry was reviewed for all patients who underwent primary ACDF for DCR. Patients were categorized into three groups depending on predominant pain location: AP predominant ([APP]; AP > NP), NP predominant ([NPP]; NP > AP), and equal pain predominance ([EPP]; NP = AP). Patients were prospectively followed for at least 2 years. RESULTS In total, 303 patients were included: 27.4% APP, 38.9% NPP, and 33.7% EPP cases. The APP group was significantly older (P = 0.030), although there were no other preoperative differences among the three groups. After adjusting for baseline differences, the SF-36 Physical Component Summary was significantly better in the APP group at 6 months (P = 0.048) and 2 years (P = 0.039). In addition, they showed a trend towards better 6-month Neck Disability Index (P = 0.077) and 2-year SF-36 Mental Component Summary (P = 0.059). However, an equal proportion of patients in each group achieved the Minimal Clinically Important Difference for each outcome, were satisfied, and returned to work 2 years after surgery. CONCLUSION Although patients with NPP had slightly poorer function and quality of life, all patients experienced a clinically meaningful improvement in patient-reported outcomes, regardless of the predominant pain location. High rates of satisfaction and return-to-work were also achieved. In the context of proper indications, these findings suggest that ACDF can be equally effective for DCR patients with varying combinations of NP or AP.Level of Evidence: 3.
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Affiliation(s)
- Graham S Goh
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Wai-Mun Yue
- The Orthopedic Centre, Mount Elizabeth Medical Center, Singapore
| | - Chang-Ming Guo
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
| | - Seang-Beng Tan
- Orthopedic and Spine Clinic, Mount Elizabeth Medical Center, Singapore
| | - John Li-Tat Chen
- Department of Orthopedic Surgery, Singapore General Hospital, Singapore
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Wu J, Zhang J, Xu T, Pan Y, Cui B, Wei W, Gao Y, Yu H, Huang Q, Long XQ, Zhou YF. The necessity or not of the addition of fusion to decompression for lumbar degenerative spondylolisthesis patients: A PRISMA compliant meta-analysis. Medicine (Baltimore) 2021; 100:e24775. [PMID: 33832066 PMCID: PMC8036092 DOI: 10.1097/md.0000000000024775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The new emerging application of decompression combined with fusion comes with a concern of cost performance, however, it is a lack of big data support. We aimed to evaluate the necessity or not of the addition of fusion for decompression in patients with lumbar degenerative spondylolisthesis. METHODS Potential studies were selected from PubMed, Web of Science, and Cochrane Library, and gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2020. STATA version 11.0 was exerted to process the pooled data. RESULTS Six RCTs were included in this study. A total of 650 patients were divided into 275 in the decompression group and 375 in the fusion group. No statistic differences were found in the visual analog scales (VAS) score for low back pain (weighted mean difference [WMD], -0.045; 95% confidence interval [CI], -1.259-1.169; P = .942) and leg pain (WMD, 0.075; 95% CI, -1.201-1.35; P = .908), Oswestry Disability Index (ODI) score (WMD, 1.489; 95% CI, -7.232-10.211; P = .738), European Quality of Life-5 Dimensions (EQ-5D) score (WMD, 0.03; 95% CI, -0.05-0.12; P = .43), Odom classification (OR, 0.353; 95% CI 0.113-1.099; P = .072), postoperative complications (OR, 0.437; 95% CI, 0.065-2.949; P = .395), secondary operation (OR, 2.541; 95% CI 0.897-7.198; P = .079), and postoperative degenerative spondylolisthesis (OR = 8.59, P = .27). Subgroup analysis of VAS score on low back pain (OR = 0.77, 95% CI, 0.36-1.65; P = .50) was demonstrated as no significant difference as well. CONCLUSION The overall efficacy of the decompression combined with fusion is not revealed to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion.
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Affiliation(s)
- Jun Wu
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Jingwei Zhang
- Department of Psychiatry, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry, Berlin
| | - Ting Xu
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Yongli Pan
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Baolong Cui
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Wei Wei
- Department of Neurology, University Medical Center Goettingen, Goettingen, Germany
| | - Yunlong Gao
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Haiguang Yu
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Qingliang Huang
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Xin-quan Long
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
| | - Yu-fan Zhou
- Department of Neurosurgery, The fifth affiliated hospital of Nanchang University (Fu Zhou first people's hospital of Jiangxi province), Fuzhou, Jiangxi, PR China
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18
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Goh GS, Soh RCC, Yue WM, Guo CM, Tan SB, Chen JLT. The patient acceptable symptom state for the Oswestry Disability Index following single-level lumbar fusion for degenerative spondylolisthesis. Spine J 2021; 21:598-609. [PMID: 33221514 DOI: 10.1016/j.spinee.2020.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 11/02/2020] [Accepted: 11/14/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The patient acceptable symptom state (PASS) is a valuable tool for interpreting patient-reported outcomes. Previous studies have attempted to define the PASS in a heterogenous cohort with various lumbar spinal disorders and surgical procedures. PURPOSE We aimed to determine the PASS threshold for the Oswestry Disability Index (ODI) specifically for patients undergoing lumbar fusion for spondylolisthesis-associated functional disability. STUDY DESIGN Retrospective review of prospectively collected registry data. PATIENT SAMPLE There were 692 patients who underwent primary single-level minimally invasive transforaminal lumbar interbody fusion for degenerative spondylolisthesis between 2006 and 2014. OUTCOME MEASURES The ODI was collected pre-operatively, at 6 months and 2 years postoperatively. An anchor question was adapted from the NASS questionnaire, "How would you rate the overall results of your treatment?" while a validation question was taken from the same questionnaire, "Has the surgery for your back condition met your expectations so far?" METHODS Responses to the anchor question were used to determine whether a PASS was achieved. Receiver operating characteristics curve analysis was performed to assess the ability of the ODI to discriminate between an acceptable/unacceptable symptom state as well as to define PASS thresholds. Sensitivity analyses were performed for different follow-up periods (6 months, 2 years), subgroups (by age, gender, BMI, and comorbidity burden), baseline ODI tertiles, and an alternate definition of PASS. RESULTS In total, 529 of 692 (76%) patients completed 2-year follow-up, of which, 89% considered their symptom state to be acceptable. Areas under the curve (AUC) ranged from 0.81 to 0.90 for all receiver operating characteristics analyses, indicating that the ODI had an excellent discriminative ability. The PASS threshold was ≤18.09 at 6 months (AUC 0.81, sensitivity 77%, specificity 72%) and ≤15.27 at 2 years (AUC 0.86, sensitivity 79%, specificity 79%). These thresholds proved to be robust in the sensitivity analyses, showing minimal variation across different patient subgroups and baseline score tertiles. CONCLUSIONS Patients with an ODI of ≤15.27 can be considered to have achieved a PASS after lumbar fusion for degenerative spondylolisthesis. These findings will help surgeons to contextualize a patient's functional recovery after lumbar spine surgery and enable researchers to define clinically relevant benchmarks when designing trials utilizing the ODI.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore.
| | - Reuben Chee Cheong Soh
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
| | - Wai-Mun Yue
- The Orthopaedic Centre, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510 Singapore
| | - Chang-Ming Guo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
| | - Seang-Beng Tan
- Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, 228510 Singapore
| | - John Li-Tat Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Rd, 169865 Singapore
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19
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Shinonara K, Ugawa R, Arataki S, Nakahara S, Takeuchi K. Charlson comorbidity index is predictive of postoperative clinical outcome after single-level posterior lumbar interbody fusion surgery. J Orthop Surg Res 2021; 16:235. [PMID: 33785033 PMCID: PMC8008557 DOI: 10.1186/s13018-021-02377-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background In several previous studies, Charlson comorbidity index (CCI) score was associated with postoperative complications, mortality, and re-admission. There are few reports about the influence of CCI score on postoperative clinical outcome. The purpose of this study was to investigate the influence of comorbidities as calculated with CCI on postoperative clinical outcomes after PLIF. Methods Three hundred sixty-six patients who underwent an elective primary single-level PLIF were included. Postoperative clinical outcome was evaluated with the Japanese Orthopaedic Association lumbar score (JOA score). The correlation coefficient between the CCI score and postoperative improvement in JOA score was investigated. Patients were divided into three groups according to their CCI score (0, 1, and 2+). JOA improvement rate, length of stay (LOS), and direct cost were compared between each group. Postoperative complications were also investigated. Results There was a weak negative relationship between CCI score and JOA improvement rate (r = − 0.20). LOS and direct cost had almost no correlation with CCI score. The JOA improvement rate of group 0 and group 1 was significantly higher than group 2+. LOS and direct cost were also significantly different between group 0 and group 2+. There were 14 postoperative complications. Adverse postoperative complications were equivalently distributed in each group, and not associated with the number of comorbidities. Conclusions A higher CCI score leads to a poor postoperative outcome. The recovery rate of patients with two or more comorbidities was significantly higher than in patients without comorbidities. However, the CCI score did not influence LOS and increased direct costs. The surgeon must take into consideration the patient’s comorbidities when planning a surgical intervention in order to achieve a good clinical outcome.
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Affiliation(s)
- Kensuke Shinonara
- Okayama Medical Center, Department of Orthopaedic Surgery, National Hospital Organization, 1711-1 Tamasu, Kitaku, Okayama city, Japan.
| | - Ryo Ugawa
- Okayama Medical Center, Department of Orthopaedic Surgery, National Hospital Organization, 1711-1 Tamasu, Kitaku, Okayama city, Japan
| | - Shinya Arataki
- Okayama Medical Center, Department of Orthopaedic Surgery, National Hospital Organization, 1711-1 Tamasu, Kitaku, Okayama city, Japan
| | - Shinnosuke Nakahara
- Okayama Medical Center, Department of Orthopaedic Surgery, National Hospital Organization, 1711-1 Tamasu, Kitaku, Okayama city, Japan
| | - Kazuhiro Takeuchi
- Okayama Medical Center, Department of Orthopaedic Surgery, National Hospital Organization, 1711-1 Tamasu, Kitaku, Okayama city, Japan
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20
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Mannion AF, Mariaux F, Pittet V, Steiger F, Aepli M, Fekete TF, Jeszenszky D, O'Riordan D, Porchet F. Association between the appropriateness of surgery, according to appropriate use criteria, and patient-rated outcomes after surgery for lumbar degenerative spondylolisthesis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:907-917. [PMID: 33575818 DOI: 10.1007/s00586-021-06725-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/13/2020] [Accepted: 01/06/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Treatment failures in spine surgery are often attributable to poor patient selection and the application of inappropriate treatment. We used published appropriate use criteria (AUC) to evaluate the appropriateness of surgery in a large group of patients operated for lumbar degenerative spondylolisthesis (LDS) and to evaluate its association with outcome. METHODS This was a retrospective analysis of prospectively collected outcome data from patients operated in our Spine Centre, 2005-2012. Appropriateness of surgery was judged based on the AUC. Patients had completed the multidimensional Core Outcome Measures Index (COMI) before surgery and at 3 months' and 1, 2 and 5 years' follow-up (FU). RESULTS In total, 448 patients (69.8 ± 9.6 years; 323 (72%) women) were eligible for inclusion and the AUC could be applied in 393 (88%) of these. Surgery was considered appropriate (A) in 234 (59%) of the patients, uncertain/equivocal (U) in 90 (23%) and inappropriate (I) in 69 (18%). A/U patients had significantly (p < 0.05) greater improvements in COMI than I patients at each FU time point. The minimal clinically important change (MCIC) score for COMI was reached by 82% A, 76% U and 54% I patients at 1-year FU (p < 0.001, I vs A and U); the odds of achieving MCIC were 3-4 times greater in A/U patients than in I patients. CONCLUSIONS The results suggest a relationship between appropriateness of surgery for LDS and the improvements in COMI score after surgery. The findings require confirmation in prospective studies that also include a control group of non-operated patients.
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Affiliation(s)
- Anne F Mannion
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Francine Mariaux
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Valérie Pittet
- Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Felix Steiger
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Martin Aepli
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamás F Fekete
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dezső Jeszenszky
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - Dave O'Riordan
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
| | - François Porchet
- Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland
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21
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Chen B, Lv Y, Wang ZC, Guo XC, Chao CZ. Decompression with fusion versus decompression in the treatment of lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21973. [PMID: 32957316 PMCID: PMC7505294 DOI: 10.1097/md.0000000000021973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. METHODS Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26-1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394-2.343), operative time (WMD: 80.399, 95%CI: 44.397-116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008-520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006-0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82-1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. CONCLUSION Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.
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Affiliation(s)
- Bo Chen
- Department of Orthopedics, Linyi Central Hospital, Linyi
| | - Yao Lv
- Shandong University, Jinan
- Department of Orthopedics, the Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Zhi-Cui Wang
- Department of Orthopedics, Linyi Central Hospital, Linyi
| | - Xiu-Cheng Guo
- Department of Orthopedics, the Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
| | - Chu-Zhang Chao
- Department of Orthopedics, the Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong, China
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22
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Ren Z, Li Z, Li S, Xu D, Chen X. Modified Facet Joint Fusion for Lumbar Degenerative Disease: Case Series of a Fusion Technique, Clinical Outcomes, and Fusion Rate in 491 Patients. Oper Neurosurg (Hagerstown) 2020; 19:255-263. [PMID: 32469075 DOI: 10.1093/ons/opaa147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Controversy still exists regarding the optimal fusion technique for the treatment of unstable lumbar spondylolisthesis. OBJECTIVE To evaluate the safety and efficacy of modified facet joint fusion (MFF). METHODS A total of 491 patients with unstable lumbar spondylolisthesis who underwent MFF were retrospectively reviewed. Computed tomography was used to evaluate the fusion rate of MFF at 6- and 12-mo follow-up postoperatively. Clinical outcomes included visual analog scale pain scores for low back pain (VAS-LBP) and leg pain (VAS-LP), Japanese Orthopedic Association scores (JOA), and Oswestry Disability Index (ODI), all of which were obtained preoperatively and postoperatively at 1-, 3-, 6-, and 12-mo follow-up times. The clinical outcomes were determined to be excellent, good, fair, or poor according to the MacNab classification at the last follow-up time. RESULTS Of the 491 patients, the fusion rates at the 6-mo and 1-yr follow-up were 56.8% and 96.1%, respectively. Between baseline and 1-yr follow-up time, VAS-LP and VAS-LBP improved from 5.6 ± 0.9 to 0.4 ± 0.5 and 5.1 ± 1.2 to 1.5 ± 0.9, respectively (P < .001). JOA improved from 9.0 ± 2.0 to 27.7 ± 1.0, and ODI decreased from 64.0 ± 2.0 to 19 ± 1.0 (P < .001). At the final evaluation, 93.6% patients showed excellent or good results, and 3.2% showed fair results. There were no MFF technique-related complications. CONCLUSION MFF technique achieved satisfactory clinical outcomes and fusion rate and appears to be a promising alternative fusion technique for the treatment of unstable lumbar spondylolisthesis.
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Affiliation(s)
- Zhinan Ren
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Derong Xu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Ha DH, Kim TK, Oh SK, Cho HG, Kim KR, Shim DM. Results of Decompression Alone in Patients with Lumbar Spinal Stenosis and Degenerative Spondylolisthesis: A Minimum 5-Year Follow-up. Clin Orthop Surg 2020; 12:187-193. [PMID: 32489540 PMCID: PMC7237244 DOI: 10.4055/cios19110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/04/2019] [Indexed: 11/06/2022] Open
Abstract
Background Surgical treatment consisting of decompression and fusion is generally known to produce good clinical results for lumbar spinal stenosis with degenerative spondylolisthesis. However, the clinical outcome of decompression alone, without fusion, remains unclear, and long-term follow-up results are scarce. This study aimed to retrospectively analyze the 5-year clinical results of decompression only in patients with lumbar spinal stenosis and degenerative spondylolisthesis. Methods Among the patients diagnosed as having lumbar spinal stenosis with degenerative spondylolisthesis, 36 patients who underwent decompression without fusion and were followed up for minimum 5 years were included in this study. The average follow-up period was 7.2 years, and the mean age of patients was 63.2 years. Visual analog scale (VAS) score and Oswestry disability index (ODI) were investigated pre- and postoperatively, and also radiologic displacement and instability were measured. In addition, patients who needed fusion or redecompression at the decompression site postoperatively were also investigated. Results VAS score and ODI improved from an average of 7.8 points and 57 points preoperatively, respectively, to 1.4 points and 19 points at 5 years postoperatively, respectively. The degree of radiologic displacement increased from an average of 5.1 mm preoperatively to 6.4 mm at the final follow-up. Radiological instability was detected in five patients. Two patients (9.5%) required fusion. Conclusions The long-term follow-up results revealed that satisfactory clinical outcomes were obtained with decompression alone, without fusion, for patients with lumbar spinal stenosis and degenerative spondylolisthesis.
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Affiliation(s)
- Dae-Ho Ha
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Tae-Kyun Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Sung-Kyun Oh
- Department of Orthopaedic Surgery, Wonkwang University Sanbon Hospital, Gunpo, Korea
| | - Hyung-Gyu Cho
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Keon-Rok Kim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Dae-Moo Shim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
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24
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Iii WS, Orías AAE, Shifflett GD, Lee JYB, Siemionow K, Gandhi S, Fogg L, Samartzis D, Inoue N, An HS. Image-Based Markers Predict Dynamic Instability in Lumbar Degenerative Spondylolisthesis. Neurospine 2020; 17:221-227. [PMID: 32252172 PMCID: PMC7136107 DOI: 10.14245/ns.1938440.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Objective To identify possible radiographic predictors markers of dynamic instability including disc height (DH), disc degeneration, and spondylosis in the setting of degenerative spondylolisthesis (DS).
Methods A retrospective review with prospectively collected data was performed on 125 patients with L4–5 DS who underwent decompression and fusion. Patients were divided into groups with dynamic instability and those without. Radiographs of the lumbar spine in neutral, flexion, and extension were used to determine degree of slip, DH, translational motion, angular motion, spondylotic changes, and lumbar lordosis. Magnetic resonance imaging (MRI) scans were reviewed to assess disc degeneration.
Results Thirty-one percent of the patients met criteria for dynamic instability. Significant correlations (p < 0.05) were found between preserved DH and dynamic instability; increased spondylotic changes and decreased translational motion; as well as advanced MRI-based disc degeneration scores with decreased angular motion, respectively. Six radiographic parameters were utilized to create a predictive model for dynamic instability, and a receiver operating characteristic curve was able to validate the predictive model (area = 0.891, standard error = 0.034, p < 0.001).
Conclusion In DS patients, preserved DH was significantly related to dynamic instability. This finding may represent a greater potential for slip progression over time in these patients. In contrast, disc degeneration on MRI, and spondylotic changes were inversely related to dynamic instability and may represent restabilization mechanisms that decrease the chance of future slip progression in DS.
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Affiliation(s)
- William Slikker Iii
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA.,College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Alejandro A Espinoza Orías
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Grant D Shifflett
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Joe Y B Lee
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Krzysztof Siemionow
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Sapan Gandhi
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Louis Fogg
- College of Nursing, Rush University Medical Center, Chicago, IL, USA
| | - Dino Samartzis
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Nozomu Inoue
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.,International Spine Research and Innovation Initiative, RUSH University Medical Center, Chicago, IL, USA
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25
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Khan JM, Harada GK, Basques BA, Nolte MT, Louie PK, Iloanya M, Tchalukov K, Berkowitz M, Derman P, Colman M, An HS. Patients with predominantly back pain at the time of lumbar fusion for low-grade spondylolisthesis experience similar clinical improvement to patients with predominantly leg pain: mid-term results. Spine J 2020; 20:276-282. [PMID: 31563578 DOI: 10.1016/j.spinee.2019.09.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patients with back pain predominance (BPP) have traditionally been thought to derive less predictable symptomatic relief from lumbar fusion surgery. PURPOSE To compare postoperative clinical outcomes as well as degree of improvement in clinical outcome measures between patients with BPP and patients with leg pain predominance (LPP) undergoing open posterior lumbar fusion. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE Analysis of patients who underwent an open posterior lumbar fusion for low-grade (Meyerding Grade I or II) degenerative or isthmic spondylolisthesis from 2011 to 2018 was conducted. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. Patients were excluded if they were under 18 years of age at the time of surgery, had less than 6 months of follow-up, presented with a lumbar vertebral body fracture, tumor, or infection, or underwent a fusion surgery that extended to the thoracic spine, high-grade spondylolisthesis, or concomitant deformity. OUTCOME MEASURES Radiographs obtained at preoperative, immediate postoperative, and final visits were evaluated for presence or absence of fusion. Patient-reported outcomes were recorded at preoperative and final clinic visits that included: visual analog scale (VAS) back/leg pain, and Oswestry disability index (ODI). Achievement of minimal clinically important difference (MCID) was analyzed, along with rates of postoperative complication and reoperation. METHODS Preoperative and final patient-reported outcomes were obtained. Achievement of MCID was evaluated using following thresholds: ODI 14.9, VAS-back pain 2.1, VAS-leg pain 2.8. For analysis, patients were divided into two groups based on predominant location of pain: predominantly VAS-back pain (BPP) and predominantly VAS-leg pain (LPP). RESULTS One hundred forty-one patients met inclusion criteria. Of these, 71 had LPP, and 70 had BPP. Patients with preoperative LPP experienced greater improvements in VAS-leg (p<.001) compared to those with BPP, whereas patients with preoperative BPP experienced greater improvements in VAS-back (p=.011) postoperatively compared to those with LPP. There were no differences in the final clinical outcomes. Additionally, LPP achieved MCID for VAS-leg (p=.027) at significantly higher proportion than BPP and BPP achieved MCID for VAS-back (p=.050) at significantly higher proportion than LPP. CONCLUSIONS Patients with low-grade spondylolisthesis who underwent an open posterior lumbar fusion had improvement in symptoms regardless of presentation with BPP or LPP. In properly indicated patients, posterior spinal fusion is effective for those with BPP in the setting of experiencing both leg and back pain, and clinicians can use this information for perioperative discussions and surgical decision-making.
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Affiliation(s)
- Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Garrett K Harada
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Michael T Nolte
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael Iloanya
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Konstantin Tchalukov
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mark Berkowitz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Peter Derman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew Colman
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Xu S, Wang J, Liang Y, Zhu Z, Wang K, Qian Y, Liu H. Decompression with fusion is not in superiority to decompression alone in lumbar stenosis based on randomized controlled trials: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2019; 98:e17849. [PMID: 31725625 PMCID: PMC6867750 DOI: 10.1097/md.0000000000017849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Although some studies had been published, it was more controversial on the superiority of decompression alone (D) and decompression with fusion (F) for the treatment of lumbar spinal stenosis (LSS) recently, especially newest articles with different opinions. A meta-analysis was performed to compare efficacy on D and F for LSS regardless of degenerative spondylolisthesis (DS) with randomized controlled trials (RCTs). METHODS The databases include PUBMED/MEDLINE, EMBASE, Cochrane Library, and Web of Science from January 1970 to December 2018. The information of screened studies included demographics, clinical outcomes, and secondary measures, then data synthesis and meta-analysis were progressed. Subgroup analysis was stratified by DS and follow-up time (36 months). Continuous variables and dichotomous variables were respectively reported as weighted mean difference and odds ratios (ORs). The strength of evidence was evaluated by the grades of recommendation, assessment, development, and evaluation (GRADE) system. RESULTS Nine RCTs met inclusion criteria with a total of 857 patients (367 were in D group and 490 were in F group). There were no statistical difference in visual analog scale changes on back and leg pain between D and F group (mean difference [MD] = -0.03, 95% confidence interval [CI] [-0.38, 0.76], z = 0.08, P = .94; MD = 0.11, 95% CI [-1.08, 1.30], z = 0.18, P = .86, respectively); patients' satisfaction was of no difference between the 2 groups, together with the change of the Oswestry disability index and European quality of life-5 dimensions (P > .05). There were no difference in the rate of complication (P = .50) and reoperation (P = .11) while a statistical significance of longer operation duration (P < .0001), more blood loss (P = .004) but amazing lower rate of adjacent segment degenerative/disease (ASD) (OR = 2.35, P = .02) in F group. The subgroup analysis on DS showed that basically all measures were in consistency with meta-analysis. There was a higher reoperation rate in middle-to-long term (>36 months) in D group and ASD was the most seasons of reoperation no matter the follow-up time. According to the GRADE system, the grade of this meta-analysis was of "High" quality. CONCLUSION F group has no better clinical results than D alone in LSS, regardless of DS and follow-up. The conclusion is of "High" quality and the grade strength of recommendation was "Strong."
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Affiliation(s)
- Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
| | - Jinyu Wang
- Department of Spinal and Joint Surgery, Taishan Medical University Affiliated Qingdao Hospital, Taishan Medical University, Qingdao, Shandong, P.R. China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
| | - Zhenqi Zhu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
| | - Kaifeng Wang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
| | - Yalong Qian
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing
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Krishnan A, Kulkarni M, Singh M, Reddy C, Mayi S, Devanand D, Rai RR, Dave BR. Trans-foraminal endoscopic uniportal decompression in degenerative lumbar spondylolisthesis: a technical and case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0065-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Degenerative spondylolisthesis is a common spinal pathology. Traditionally, spinal fusion is an accepted standard surgical treatment for listhesis. But fusion is a major intervention with its known pitfalls. With technological progression, minimally invasive spinal fusion (MISF) procedures are becoming mainstream. Percutaneous trans-foraminal endoscopic lumbar discectomy/decompressions (PTELD) without stabilization has many advantages over even a MISF for select group of patients.
Case presentation
In this case report, we describe using a uniportal unilateral trans-foraminal approach (TFA) for stable listhesis with lumbar disc herniation (LDH) causing chronic bilateral radicular symptoms and back pain with acute exacerbation. Under local anesthesia, we used a flat entry for PTELD, which facilitates an approach to both disc sides ventrally and even dorsal aspect lateral recess decompression on the dominant ipsilateral side. No fixation was done. An excellent outcome is obtained immediately at 6 weeks and maintained at 39 months of follow-up.
Conclusion
PTELD is worth considering as an intermediate procedure before fusion is offered in lateral recess stenosis in stable listhesis patients who have consented and understand the progressive cascade of spinal degeneration.
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Reoperation Rate After Microsurgical Uni- or Bilateral Laminotomy for Lumbar Spinal Stenosis With and Without Low-grade Spondylolisthesis: What do Preoperative Radiographic Parameters Tell Us? Spine (Phila Pa 1976) 2019; 44:E245-E251. [PMID: 30015718 DOI: 10.1097/brs.0000000000002798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective single-center cohort study. OBJECTIVE The aim of this study was to analyze the influence of preoperative radiographic parameters on reoperation rates after microsurgical laminotomy for lumbar spinal stenosis (LSS). SUMMARY OF BACKGROUND DATA Decompression for symptomatic LSS has shown to be effective. However, the optimal surgical strategy remains a matter of debate, especially with underlying spondylolisthesis. METHODS Adult patients with LSS who underwent primary laminotomy without fusion between January 2012 and September 2013 at our institution were included for analysis. Disc height (in mm), facet joint (FJ) orientation (degrees), and grade of spondylolisthesis of all surgical index levels (SILs) were analyzed from preoperative magnetic resonance imaging. Patients were contacted in January 2017 by follow-up phone call (mean follow-up 49 months) regarding lumbar reoperation. RESULTS A total of 161 patients (mean age 68.5 yrs, ±11.3) and 236 SILs were analyzed. Fifty-six patients (34.8%) had low-grade spondylolisthesis involving 60 SILs (25.4%). Twenty-four patients (14.9%) underwent reoperation involving 32 levels. Of latter, 23 SILs (9.7%) had recurrent stenosis (RS) and 9 (3.8%) had adjacent level stenosis. Five patients in total (3.1%) required secondary fusion; all had preexisting spondylolisthesis. SILs with spondylolisthesis had a significantly higher rate of RS requiring reoperation compared with SILs without spondylolisthesis [18.3% (11/60) vs. 6.8% (12/176), P = 0.013]. Disc height and FJ orientation showed no significant difference between patients with and without reoperation, or with and without spondylolisthesis. CONCLUSION Decompression alone is reasonable for most patients with LSS and stable low-grade spondylolisthesis. The overall reoperation rate and need for secondary fusion were low in our series. However, patients with spondylolisthesis had a higher rate of reoperation for RS after laminotomy without fusion. This must be taken into account for preoperative risk-benefit analysis, tailored surgical decision making and patient counseling. LEVEL OF EVIDENCE 4.
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Surgical training in spine surgery: safety and patient-rated outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:807-816. [DOI: 10.1007/s00586-019-05883-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
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Omidi-Kashani F, Jalilian R, Golhasani-Keshtan F. Effect of interbody fusion cage on clinical and radiological outcome of surgery in L4-L5 lumbar degenerative spondylolisthesis. JOURNAL OF SPINE SURGERY 2018; 4:109-114. [PMID: 29732430 DOI: 10.21037/jss.2018.03.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Lumbar degenerative spondylolisthesis (LDS) is a degenerative slippage of a lumbar vertebra relative to the adjacent vertebra below that can be clinically symptomatic. We aim to compare radiological and clinical outcome of surgery in L4-L5 LDS with or without applying the interbody fusion cage. Methods We studied 60 patients (mean age, 51.3±13.2 years; follow-up, 53.3±14.6 months) with L4-L5 LDS who had been treated by decompression, pedicle screw and rod instrumentation associated with posterolateral fusion (PLF) without and with transforaminal lumbar interbody fusion (TLIF) in equally divided groups A and B, respectively. Intraoperative parameters were recorded and outcome assessment carried out by visual analog scale (VAS), Oswestry Disability Index questionnaire (ODI), subjective satisfaction, radiologic union, and loss of reduction. We judged the differences by t-test and cross-tab. Results Using an interbody fusion cage was associated with a significant increase in intraoperative blood loss, operative time, and instrument cost. Improvement in VAS and ODI were significant but comparable. Satisfaction rate was higher in group A (P=0.52). Fusion rate and loss of correction were more favorable in group B but these differences were not significant. Conclusions In the surgical treatment of the patients with L4-L5 LDS, interbody fusion cage probably does not significantly improve the radiologic and clinical outcomes and may also be associated with more complication and morbidity.
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Affiliation(s)
- Farzad Omidi-Kashani
- Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Jalilian
- Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Golhasani-Keshtan
- Orthopedic Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1629-1643. [PMID: 29404693 DOI: 10.1007/s00586-017-5436-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/01/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
Abstract
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. These slides can be retrieved under Electronic Supplementary Material.
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Yavin D, Casha S, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N. Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis. Neurosurgery 2018; 80:701-715. [PMID: 28327997 DOI: 10.1093/neuros/nyw162] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 01/01/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS A systematic review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
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Affiliation(s)
- Daniel Yavin
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Steven Casha
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Samuel Wiebe
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Thomas E Feasby
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Callie Clark
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Albert Isaacs
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Jayna Holroyd-Leduc
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - R John Hurlbert
- Division of Neurosurgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Garnette R Sutherland
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Nathalie Jette
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Canada.,Division of Neurology, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.,The O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
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Chen Z, Xie P, Feng F, Chhantyal K, Yang Y, Rong L. Decompression Alone Versus Decompression and Fusion for Lumbar Degenerative Spondylolisthesis: A Meta-Analysis. World Neurosurg 2017; 111:e165-e177. [PMID: 29248779 DOI: 10.1016/j.wneu.2017.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/03/2017] [Accepted: 12/05/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of decompression alone (D group) with decompression and fusion (DF group) for patients who were diagnosed with lumbar degenerative spondylolisthesis (LDS). METHODS Electronic databases were searched for relevant studies that compared decompression alone with decompression and fusion for LDS. Then, data extraction and quality assessment were conducted, and the extracted data were analyzed by using RevMan 5.3. We used the random effects model for studies that had heterogeneity between them, and for those without heterogeneity, the fixed model was used. RESULTS Four randomized controlled trials and 14 nonrandomized controlled studies involving 77,994 patients were included for this meta-analysis. Although the DF group was associated with a higher postoperative change score on a visual analog scale compared with the D group in terms of back (P = 0.02) and leg (P = 0.04), they failed to reach the minimum clinically important difference. Moreover, no significant differences were found in Oswestry Disability Index, European Quality of Life-5 Dimensions, Short-Form 36 physical and mental component summaries score, and patients' satisfaction (P > 0.05) between treatment groups. Complication rate and reoperation rate (P > 0.05) were similar in both groups. Data analysis also showed that the DF group was associated with longer operation time (P < 0.00001), more intraoperative blood loss (P < 0.00001), and longer length of hospital stay (P < 0.00001). CONCLUSIONS Among patients with LDS, decompression and fusion surgery did not yield better clinical outcomes than decompression alone surgery. Also, the complication rate and reoperation rate were comparable between treatment groups. However, patients who had undergone decompression alone had shorter operation time, less intraoperative blood loss, and shorter hospital stay.
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Affiliation(s)
- Zihao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kishor Chhantyal
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Campbell RC, Mobbs RJ, Lu VM, Xu J, Rao PJ, Phan K. Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis. Global Spine J 2017; 7:482-490. [PMID: 28811993 PMCID: PMC5544162 DOI: 10.1177/2192568217701103] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS. METHODS This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study. RESULTS A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index (P = .29) and visual analog scale (P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss (P = .38), reoperation rate (P = .66), hospital stay (P = .96), complication rate (P = .78), or fusion rate (P = .15). CONCLUSIONS There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.
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Affiliation(s)
- Ryan C. Campbell
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Ralph J. Mobbs
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Victor M. Lu
- University of Sydney, Sydney, New South Wales, Australia
| | - Joshua Xu
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia
| | - Prashanth J. Rao
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | - Kevin Phan
- University of New South Wales, Sydney, New South Wales, Australia,Prince of Wales Private Hospital, Sydney, New South Wales, Australia,University of Sydney, Sydney, New South Wales, Australia,Kevin Phan, NeuroSpine Surgery Research Group (NSURG), Level 7, Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales, Australia.
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Decompression plus fusion versus decompression alone for degenerative lumbar spondylolisthesis: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017. [PMID: 28647763 DOI: 10.1007/s00586-017-5200-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the clinical effectiveness of decompression plus fusion and decompression alone for patients with degenerative lumbar spondylolisthesis, a systematic review and meta-analysis of all available evidence was performed. METHODS A search of the literature was conducted on PubMed/MEDLINE, EMBASE, and the Cochrane Collaboration Library. Relevant studies comparing decompression plus fusion and decompression alone were selected according to eligibility criteria. Predefined endpoints were extracted and meta-analyzed from the identified studies. RESULTS Four randomized controlled trials and 13 observational studies were eligible. The pooled data revealed that fusion was associated with significantly higher rates of satisfaction and lower leg pain scores when compared with decompression alone. However, fusion significantly increased the intraoperative blood loss, operative time and hospital stay. Both techniques had similar ODI, back pain scores, complication rate, and reoperation rate. CONCLUSIONS Based on the available evidence, decompression plus fusion maybe be better than decompression alone in the treatment of degenerative spondylolisthesis. Fusion had advantages of improvement of clinical satisfaction, as well as reduction of postoperative leg pain, with similar complication rate to decompression alone.
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Chang W, Yuwen P, Zhu Y, Wei N, Feng C, Zhang Y, Chen W. Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2017; 137:637-650. [PMID: 28361467 DOI: 10.1007/s00402-017-2685-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The debate on efficacy of fusion added to decompression for lumbar spinal stenosis (LSS) is ongoing. No meta-analysis has compared the effectiveness of decompression versus decompression plus fusion in treating patients with LSS. METHODS A literature search was performed in the Web of Science, PubMed, Embase, and Springer databases from 1970 to 2016. Relevant references were selected and the included studies were manually reviewed. We included trials evaluating decompression surgery compared to decompression plus fusion surgery in treating patients with LSS. The primary outcomes analyzed were back pain, leg pain, Oswestry Disability Index scores (ODI), the quality-of-life EuroQol-5 Dimensions (EQ-5D), duration of operation, intraoperative blood loss, length of hospital stay, major complications, walking ability, number of reoperation, and finally clinically excellent and good rates. Data analysis was conducted using the Review Manager 5.2 software. RESULTS Fifteen studies involving 17,785 patients with LSS were included. The overall effect mean difference (MD) (95% CI) in the differences between pre- and post-operative back pain, leg pain, operative time, intraoperative blood loss, and length of stay were 0.04 (-0.36, 0.44), 0.69 (-0.38, 1.76), -2.04 (-3.12, -0.96), -3.96 (-6.64, -1.27) and -4.21 (-10.03, 1.62) (z = 0.18, 1.26, 3.71, 2.89 and 1.41, respectively; P = 0.86, 0.55, 0.0002, 0.004 and 0.16, respectively) in random effects models. The overall effect MD (95% CI) in ODI, EQ-5D, and walking ability were 0.43 (-1.15, 2.00), 0.01 (-0.01, 0.03) and 0.04 (-0.49, 0.57) (z = 0.52, 1.16 and 0.15, respectively; P = 0.59, 0.24 and 0.88, respectively) in fixed effects models. The overall effect odds ratio (OR) (95% CI) of major complications, number of reoperations, and clinically excellent and good rates between the two groups were 0.70 (0.60, 0.81), 1.04 (0.90, 1.19) and 0.31 (0.06, 1.59) (z = 4.63, 0.53 and 1.40, respectively; P < 0.00001, 0.60 and 0.16, respectively). Our study reveals no difference in the effectiveness between the two surgical techniques. CONCLUSIONS The additional fusion in the management of LSS yielded no clinical improvements over decompression alone within a 2-year follow-up period. But fusion resulted in a longer duration of operation, more blood loss, and a higher risk of complications. Therefore, the appropriate surgical protocol for LSS should be discussed further.
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Affiliation(s)
- Wenli Chang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Peizhi Yuwen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Yanbing Zhu
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Ning Wei
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Chen Feng
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wei Chen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, NO. 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review. EFORT Open Rev 2017; 1:267-274. [PMID: 28461958 PMCID: PMC5367584 DOI: 10.1302/2058-5241.1.000030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population.Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment.A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined.The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis. Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030.
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Affiliation(s)
- Augusto Covaro
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | | | | | - Maite T Ubierna
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
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Du Plessis PNB, Lau BPH, Hey HWD. Traumatic dislocation of the S1 polyaxial pedicle screw head: a case report. JOURNAL OF SPINE SURGERY 2017; 3:95-101. [PMID: 28435927 DOI: 10.21037/jss.2017.03.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Polyaxial screw head dislocation in the absence of a manufacture defect is extremely rare and represents a biomechanical overload of the screw, leading to early failure. A 58-year-old gentleman underwent instrumented fusion using polyaxial pedicle screws-titanium rod construct with interbody cage for spondylolytic spondylolisthesis at the L5/S1 level. He attempted to bend forward ten days after the surgery which resulted in a dislocation of the right S1 polyaxial screw head from the screw shank with recurrence of symptoms. He underwent revision surgery uneventfully. This case highlights the need to pay particular attention to the strength of fixation and the amount of release to avoid such a complication.
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Affiliation(s)
- Pieter N B Du Plessis
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Bernard P H Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
| | - Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore
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Stokes OM, Cole AA, Breakwell LM, Lloyd AJ, Leonard CM, Grevitt M. Do we have the right PROMs for measuring outcomes in lumbar spinal surgery? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:816-824. [DOI: 10.1007/s00586-016-4938-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 12/04/2016] [Accepted: 12/25/2016] [Indexed: 10/20/2022]
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Clinical and Radiological Study Focused on Relief of Low Back Pain After Decompression Surgery in Selected Patients With Lumbar Spinal Stenosis Associated With Grade I Degenerative Spondylolisthesis. Spine (Phila Pa 1976) 2016; 41:E1434-E1443. [PMID: 27488289 DOI: 10.1097/brs.0000000000001813] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim of the present study was to identify the clinical and radiological features of low back pain (LBP) that was relieved after decompression alone of lumbar spinal stenosis (LSS) associated with grade I lumbar degenerative spondylolisthesis (LDS). SUMMARY OF BACKGROUND DATA Although decompression and fusion are generally the recommended surgical treatments of LDS, several authors have reported that some patients with LDS could obtain good clinical results including relief from LBP by decompression alone. The pathogenesis of relief from LBP after decompression is, however, not known. METHODS Forty patients with LSS associated with grade I LDS, who underwent a minimally invasive surgical-decompression were enrolled in the present study. All patients complained preoperatively of predominantly leg-related symptoms and LBP (≥ 4 points on Numeric Rating Scale). Clinical and radiological assessments were performed 1 year after surgery (a relief of LBP: Numeric Rating Scale reduction ≥3 points and valuation ≤3 points) and at the last follow-up. We conducted a comparative study between patient groups with and without the relief from LBP (groups R and N, respectively). RESULTS Twenty-nine patients were distributed to group R and the remaining 11 patients to group N. Preoperatively, there was a significant difference between the two groups for age and radiographic flexibility for lumbar extension. Postoperatively, there was a positive correlation between improvement in both LBP and leg symptoms. The clinical outcomes of group R were significantly better than those of group N throughout follow-up period (mean 37 mo). In group R, sagittal lumbopelvic radiographic parameters improved significantly after surgery. CONCLUSION Although the causes of LBP are varied in each patients, our results show that concomitant LSS itself might cause LBP in some patients with grade I LDS, because it involves impingement of the neural tissue and discordant sagittal lumbopelvic alignment. LEVEL OF EVIDENCE 3.
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Káplár Z, Wáng YXJ. South Korean degenerative spondylolisthesis patients had surgical treatment at earlier age than Japanese, American, and European patients: a published literature observation. Quant Imaging Med Surg 2016; 6:785-790. [PMID: 28090453 DOI: 10.21037/qims.2016.11.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Zoltán Káplár
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, China
| | - Yì-Xiáng J Wáng
- Department of Imaging and Interventional Radiology, the Chinese University of Hong Kong, Hong Kong, China
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Wang YXJ, Káplár Z, Deng M, Leung JCS. Lumbar degenerative spondylolisthesis epidemiology: A systematic review with a focus on gender-specific and age-specific prevalence. J Orthop Translat 2016; 11:39-52. [PMID: 29662768 PMCID: PMC5866399 DOI: 10.1016/j.jot.2016.11.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The epidemiology of lumbar degenerative spondylolisthesis (DS) remains controversial. We performed a systematic review with the aim of gaining a better understanding of the prevalence of DS in the general population. The results showed that the prevalence of DS is very gender- and age-specific. Few women and men develop DS before they are 50 years old. After 50 years of age, both women and men begin to develop DS, with women having a faster rate of development than men. For elderly Chinese (≥ 65 years, mean age: 72.5 years), large population-based studies MsOS (Hong Kong, females: n = 2000) and MrOS (Hong Kong, males: n = 2000) showed DS prevalence was 25.0% in women and 19.1% in men. The female:male (F:M) prevalence ratio was 1.3:1. The published data for MsOS (USA) and MrOS (USA) studies seem to show that elderly Caucasian Americans have a higher DS prevalence, being approximately 60-70% higher than elderly Chinese; however, the F:M prevalence ratio was similar to the elderly Chinese population. Patient data showed that female patients more often received surgical treatment than male and preliminary data showed the ratio of female to male patients receiving surgical treatment did not differ between Northeast Asians (Chinese, Japanese, and Korean), Europeans, and American Caucasians, being around 2:1 in the elderly population. The existing data also suggest that menopause may be a contributing factor for the accelerated development of DS in postmenopausal women. The translational potential of this article: A better understanding of epidemiology of lumbar degenerative spondylolisthesis can support patient consultation and treatment planning.
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Affiliation(s)
- Yi Xiang J Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Zoltán Káplár
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Jason C S Leung
- School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong Special Administrative Region
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Ghasemi AA. Transforaminal lumbar interbody fusion versus instrumented posterolateral fusion In degenerative spondylolisthesis: An attempt to evaluate the superiority of one method over the other. Clin Neurol Neurosurg 2016; 150:1-5. [DOI: 10.1016/j.clineuro.2016.08.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 11/26/2022]
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Austevoll IM, Gjestad R, Brox JI, Solberg TK, Storheim K, Rekeland F, Hermansen E, Indrekvam K, Hellum C. 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. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:404-413. [PMID: 27421276 DOI: 10.1007/s00586-016-4683-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 06/02/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of adding fusion to decompression in patients operated for lumbar spinal stenosis with a concomitant lumbar degenerative spondylolisthesis. METHODS After propensity score matching, 260 patients operated with decompression and fusion and 260 patients operated with decompression alone were compared. Primary outcome measures were leg and back pain [Numeric Rating Scale (NRS), 0-10] and Oswestry Disability Index (ODI, 0-100) at 12 months. RESULTS At 12-month follow-up, the fusion group rated their pain significantly lower than the decompression alone group [leg pain 3.0 and 3.6, respectively, mean difference -0.6, 95 % confidence interval (CI) -1.2 to -0.05, p = 0.03 and back pain 3.3 and 3.9, respectively, mean difference -0.6, 95 % CI -1.1 to -0.1, p = 0.02]. ODI was not significantly different between the groups (21.0 versus 23.3, mean difference -2.3, 95 % CI -5.8 to 1.1, p = 0.18). Seventy-four percent of the fusion group and 63 % of the decompression alone group achieved a clinically important improvement in back pain (difference in proportion of responders = 11 %, 95 % CI 2-20 %, p = 0.01), corresponding to a number needed to treat of 9 patients (95 % CI 5-50). There was no significant difference in responder rate for leg pain (74 and 67 %, respectively, difference 7 %, 95 % CI -1 to 16 %, p = 0.09) or for ODI (67 and 59 %, respectively, difference 8 %, 95 % CI 0-18 %, p = 0.06). The duration of surgery and hospital stay was longer for the fusion group (mean difference 68 min, 95 % CI 58-78, p < 0.01 and mean difference 4.2 days, 95 % CI 3.5-4.8, p < 0.01). CONCLUSION In the present non-inferiority study, we cannot conclude that decompression alone is as good as decompression with additional fusion. However, the small differences in the groups' effect sizes suggest that a considerable number of patients can be treated with decompression alone. A challenge in future studies will be to find the best treatment option for each patient.
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Affiliation(s)
- Ivar M Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Mental Health Care, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Tore K Solberg
- Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway.,Department of Neurosurgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Kjersti Storheim
- Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- Norwegian Registry for Spine Surgery (NORspine), University Hospital of Northern Norway, Tromsø, Norway.,Clinic for Surgery and Neurology, Department of Orthopedics, Oslo University Hospital, University of Oslo, Oslo, Norway
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Snoddy MC, Sielatycki JA, Sivaganesan A, Engstrom SM, McGirt MJ, Devin CJ. Can facet joint fluid on MRI and dynamic instability be a predictor of improvement in back pain following lumbar fusion for degenerative spondylolisthesis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2408-15. [DOI: 10.1007/s00586-016-4525-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 12/27/2022]
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Guideline summary review: An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis. Spine J 2016; 16:439-48. [PMID: 26681351 DOI: 10.1016/j.spinee.2015.11.055] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/19/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The North American Spine Society's (NASS) Evidence-Based Clinical Guideline for the Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis features evidence-based recommendations for diagnosing and treating degenerative lumbar spondylolisthesis. The guideline updates the 2008 guideline on this topic and is intended to reflect contemporary treatment concepts for symptomatic degenerative lumbar spondylolisthesis as reflected in the highest quality clinical literature available on this subject as of May 2013. The NASS guideline on this topic is the only guideline on degenerative lumbar spondylolisthesis included in the Agency for Healthcare Research and Quality's National Guideline Clearinghouse (NGC). PURPOSE The purpose of this guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for patients with degenerative lumbar spondylolisthesis. This article provides a brief summary of the evidence-based guideline recommendations for diagnosing and treating patients with this condition. STUDY DESIGN A systematic review of clinical studies relevant to degenerative spondylolisthesis was carried out. METHODS This NASS spondyolisthesis guideline is the product of the Degenerative Lumbar Spondylolisthesis Work Group of NASS' Evidence-Based Guideline Development Committee. The methods used to develop this guideline are detailed in the complete guideline and technical report available on the NASS website. In brief, a multidisciplinary work group of spine care specialists convened to identify clinical questions to address in the guideline. The literature search strategy was developed in consultation with medical librarians. Upon completion of the systematic literature search, evidence relevant to the clinical questions posed in the guideline was reviewed. Work group members used the NASS evidentiary table templates to summarize study conclusions, identify study strengths and weaknesses, and assign levels of evidence. Work group members participated in webcasts and in-person recommendation meetings to update and formulate evidence-based recommendations and incorporate expert opinion when necessary. The draft guidelines were submitted to an internal peer review process and ultimately approved by the NASS Board of Directors. Upon publication, the Degenerative Lumbar Spondylolisthesis guideline was accepted into the NGC and will be updated approximately every 5 years. RESULTS Twenty-seven clinical questions were addressed in this guideline update, including 15 clinical questions from the original guideline and 12 new clinical questions. The respective recommendations were graded by strength of the supporting literature, which was stratified by levels of evidence. Twenty-one new or updated recommendations or consensus statements were issued and 13 recommendations or consensus statements were maintained from the original guideline. CONCLUSIONS The clinical guideline was created using the techniques of evidence-based medicine and best available evidence to aid practitioners in the care of patients with degenerative lumbar spondylolisthesis. The entire guideline document, including the evidentiary tables, literature search parameters, literature attrition flow chart, suggestions for future research, and all of the references, is available electronically on the NASS website at https://www.spine.org/Pages/ResearchClinicalCare/QualityImprovement/ClinicalGuidelines.aspx and will remain updated on a timely schedule.
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Decompression without Fusion for Low-Grade Degenerative Spondylolisthesis. Asian Spine J 2016; 10:75-84. [PMID: 26949462 PMCID: PMC4764545 DOI: 10.4184/asj.2016.10.1.75] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 05/25/2015] [Accepted: 06/17/2015] [Indexed: 11/09/2022] Open
Abstract
Study Design Retrospective series. Purpose Assess results of decompression-only surgery for low-grade degenerative spondylolisthesis with consideration of instability. Overview of Literature There is no consensus on whether fusion or decompression-only surgery leads to better outcomes for patients with low-grade degenerative spondylolisthesis. Current trends support fusion but many studies are flawed due to over-generalization without consideration of radiological instability and their variable presentations and natural history. Methods Patients with surgically treated degenerative spondylolisthesis from 1990–2013 were included. Clinical and radiological instability measures were included. Any residual or recurrence of symptoms, revision surgery performed and functional outcome scores including the numerical global rate of change scale, visual analogue scale, and modified Barthel index were measured. Follow-up periods for patients were divided into short-term (<5 years), mid-term (5–10 years) and long-term (>10 years). Results A total of 64 patients were recruited. Mechanical low back pain was noted in 48 patients and most (85.4%) had relief of back pain postoperatively. Radiological instability was noted in 4 subjects by flexion-extension radiographs and 12 subjects with prone traction radiographs by increased disc height and reduction of olisthesis and slip angle. From the results of the short-term, mid-term and long-term follow-up, reoperation only occurred within the first 5-year follow-up period. All functional scores improved from preoperative to postoperative 1-year follow-up. Conclusions Decompression-only for low-grade degenerative spondylolisthesis has good long-term results despite instability. Further higher-level studies should be performed on this patient group with radiological instability to suggest the superior surgical option.
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Madhavan K, Chieng LO, Hofstetter CP, Wang MY. Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis. Neurosurg Focus 2016; 40:E4. [DOI: 10.3171/2015.11.focus15512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization.
A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted.
In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.
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Affiliation(s)
- Karthik Madhavan
- 2Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Lee Onn Chieng
- 2Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Michael Y. Wang
- 2Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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Fischer CR, Cassilly R, Dyrszka M, Trimba Y, Peters A, Goldstein JA, Spivak J, Bendo JA. Cost-Effectiveness of Lumbar Spondylolisthesis Surgery at 2-Year Follow-up. Spine Deform 2016; 4:48-54. [PMID: 27852500 DOI: 10.1016/j.jspd.2015.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 05/16/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the cost/quality-adjusted life-year (QALY) of the operative treatment of lumbar spondylolisthesis and identify factors associated with cost-effectiveness at 2 years. METHODS We evaluated patients who underwent surgery for spondylolisthesis. The QALY was determined from the EQ5D. Outcomes were also assessed using the Oswestry Disability Index (ODI). Surgical, neuromonitoring, and anesthesia Current Procedural Terminology (CPT) codes as well as hospital Diagnosis-Related Group codes were used to determine the Medicare direct care costs of surgery. Indirect costs were modeled based on existing literature. A discounting rate of 3% was applied. Analysis was performed to determine which factors were associated with a cost/QALY less than $100,000. RESULTS There were 44 patients who underwent surgery for either degenerative (30) or isthmic spondylolisthesis (14). There were 27 women and 17 men, with an average age at surgery of 59.7 years (standard deviation [SD] = 14.69) and an average follow-up of 2 years (SD = 0.82). The average postoperative improvement in ODI was 24.77 (SD = 23.9), and change in QALY was 0.43 (SD = 0.30). The average cost/QALY at 2 years for direct care costs was $89,065. The average cost/QALY at 2 years for direct plus indirect costs was $112,588. Higher preoperative leg pain and greater leg pain change was associated with a cost/QALY <$100,000 (p < .005, p < .028). The cost-effective group had a higher proportion of patients with disease extent of two or more levels (p = .021). When comparing surgical techniques of anterior-posterior and posterior only, there was no difference in cost-effectiveness. CONCLUSIONS Spondylolisthesis surgery is cost-effective at 2 years, with a QALY change of 0.43 and a direct cost/QALY of $89,065. Higher preoperative leg pain and larger extent of disease was associated with cost-effectiveness. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charla R Fischer
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA.
| | - Ryan Cassilly
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA
| | - Marc Dyrszka
- Columbia University Medical Center, 630 West 168th St, New York, NY 10032, USA
| | - Yuriy Trimba
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
| | - Austin Peters
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA; Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | | | - Jeffrey Spivak
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
| | - John A Bendo
- NYU Hospital for Joint Diseases, 333 E 38th St, New York, NY 10016, USA
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Schulte TL, Ringel F, Quante M, Eicker SO, Muche-Borowski C, Kothe R. Surgery for adult spondylolisthesis: a systematic review of the evidence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 25:2359-67. [DOI: 10.1007/s00586-015-4177-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 08/01/2015] [Accepted: 08/01/2015] [Indexed: 11/29/2022]
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