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Cheng H, Luo G, Xu D, Li Y, Yang H, Cao S, Sun T. Decompression alone or fusion in single-level lumbar spinal stenosis with spondylolisthesis? A systematic review and meta analysis. BMC Musculoskelet Disord 2024; 25:726. [PMID: 39256670 PMCID: PMC11386329 DOI: 10.1186/s12891-024-07641-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 06/28/2024] [Indexed: 09/12/2024] Open
Abstract
PURPOSE The objective of this systematic review and metaanalysis is to compare the efficacy and safety of decompression alone versus decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. METHODS A comprehensive search of the PubMed, Embase, Cochrane Library, and Ovid Medline databases was conducted to find randomized control trials (RCTs) or cohort studies that compared decompression alone and decompression plus fusion in single-level lumbar spinal stenosis with spondylolisthesis. Operation time; reoperation; postoperative complications; postoperative Oswestry disability index(ODI) scores and scores related to back and leg pain were collected from eligible studies for meta-analysis. RESULTS We included 3 randomized controlled trials and 9 cohort studies with 6182 patients. The decompression alone group showed less operative time(P < 0.001) and intraoperative blood loss(p = 0.000), and no significant difference in postoperative complications was observed in randomized controlled trials(p = 0.428) or cohort studies(p = 0.731). There was no significant difference between the other two groups in reoperation(P = 0.071), postoperative ODI scores and scores related to back and leg pain. CONCLUSIONS In this study, we found that the decompression alone group performed better in terms of operation time and intraoperative blood loss, and there was no significant difference between the two surgical methods in rate of reoperation and postoperative complications, ODI, low back pain and leg pain. Therefore, we come to the conclusion that decompression alone is not inferior to decompression and fusion in patients with single-level lumbar spinal stenosis with spondylolisthesis.
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Affiliation(s)
| | - Gan Luo
- Department of Orthopedics, Chengdu Integrated Traditional Chinese Medicine &Western Medicine Hospital, Chengdu First People's Hospital, Chengdu, 610016, China
| | - Dan Xu
- Tianjin Medical University, Tianjin, 300070, China
| | - Yuqiao Li
- Peking University People's Hospital, Beijing, 100871, China
| | - Houzhi Yang
- Tianjin Medical University, Tianjin, 300070, China
| | - Sheng Cao
- Tianjin Medical University, Tianjin, 300070, China
| | - Tianwei Sun
- Tianjin Medical University, Tianjin, 300070, China.
- Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, China.
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Kaidi AC, Du JY, Subramanian T, Amen T, Asada T, Qureshi SA, Iyer S. Isolated decompression for degenerative spondylolisthesis is less costly than fusion even with high revision rates. Spine J 2024; 24:1690-1696. [PMID: 38849052 DOI: 10.1016/j.spinee.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/23/2024] [Accepted: 05/15/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND CONTEXT Isolated decompression and decompression with instrumented fusion are accepted surgical treatments for lumbar spondylolisthesis. Although isolated decompression is a less costly solution with similar patient-reported outcomes, it is associated with higher rates of reoperation than primary fusion. PURPOSE To determine the costs associated with primary decompression, primary fusion, and decompression and fusion for degenerative spondylolisthesis. We further sought to establish at what revision rate is primary decompression still a less costly surgical treatment for degenerative lumbar spondylolisthesis. STUDY DESIGN/SETTING A retrospective database study of the Medicare Provider Analysis and Review (MEDPAR) limited data set. PATIENT SAMPLE Patients who underwent single-level fusion or decompression for degenerative spondylolisthesis. OUTCOME MEASURES Cost of surgical care. METHODS All inpatient stays that underwent surgery for single-level lumbar/lumbosacral degenerative spondylolisthesis in the 2019 calendar year (n=6,653) were queried from the MEDPAR limited data set. Patients were stratified into three cohorts: primary decompression (n=300), primary fusion (n=5,757), and revision fusion (n=566). Univariate analysis was conducted to determine cost differences between these groups and results were confirmed with multivariable regression. An economic analysis was then done to determine at what revision rate would primary decompression still be a less costly treatment choice. RESULTS on univariate analysis, the cost of primary single-level decompression for spondylolisthesis was $14,690±9,484, the cost of primary single-level fusion was $26,376±11,967, and revision fusion was $26,686±11,309 (p<0.001). on multivariate analysis, primary fusion was associated with an increased cost of $3,751, and revision fusion was associated with increased cost of $7,502 (95%ci: 2,990-4,512, p<0.001). economic analysis found that a revision rate less than or equal to 43.8% would still result in primary decompression being less costly for a practice than primary fusion for all patients. CONCLUSIONS Isolated decompression for degenerative lumbar spondylolisthesis is a less costly treatment choice even with rates of revision fusion as high as 43.8%. This was true even with an assumed revision rate of 0% after primary fusion. This study solely looks at cost data, however, and many patients may still benefit from primary fusion when appropriately indicated.
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Affiliation(s)
| | - Jerry Y Du
- Hospital for Special Surgery, New York, NY, USA
| | | | - Troy Amen
- Hospital for Special Surgery, New York, NY, USA
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Boonchai K, Santipas B, Wilartratsami S, Ruangchainikom M, Korwutthikulrangsri E, Akkarawanit P, Luksanapruksa P. The Magnetic Resonance Imaging of the Psoas Muscle Area as the Prognostic Factor for Survival and Adverse Events in Spinal Metastasis Surgery. Global Spine J 2024:21925682231173366. [PMID: 39069656 DOI: 10.1177/21925682231173366] [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] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE This study aimed to evaluate the ability of the mortality and adverse events prediction following metastatic spinal surgery of MRI-based cross-sectional psoas muscle area (PMA). METHODS A retrospective chart review, 120 patients who had undergone metastatic spinal surgery were included. The cross-sectional area identified the PMA under MR-imaging at the L3 or L4 pedicle level, which was classified into 3 tertiles. We used univariate and multivariate cox proportional hazard regression to assess whether PMA was associated with 30-day, 90-day, 1-year, and overall mortality. RESULTS The small psoas tertile group populations had a higher mortality rate than the large psoas tertile group. PMA in T1 and T2 had a probability of a higher 90-d mortality rate than PMA in T3 (T1 VS T3: P = .29 and T2 VS T3: P = .12). The median survival time was 7 months, 9 months, and 10 months in PMA T1, T2, and T3, respectively. PMA in tertile 2 had a significantly higher mortality rate of 38% compared to PMA in tertile 3 (HR 1.38, 95% CI .83-2.32, P = .02). Considering PMA as a continuous variable, every 1 mm2 increment of PMA resulted in the increase survivorship of 1% (HR .99 with 95% CI .99-1). CONCLUSION The MRI-based cross-sectional PMA tends to predict the 90-d mortality rate and overall mortality rate in spinal metastasis patients who underwent spinal surgery. The PMA should be considered one of the prognostic factors in the treatment of metastatic spinal patients.
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Affiliation(s)
- Kitidate Boonchai
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Borriwat Santipas
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Monchai Ruangchainikom
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ekkapoj Korwutthikulrangsri
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pawin Akkarawanit
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Panya Luksanapruksa
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Walia A, Ani F, Maglaras C, Raman T, Fischer C. Resolution of Radiculopathy Following Indirect Versus Direct Decompression in Single Level Lumbar Fusion. Global Spine J 2024:21925682241230926. [PMID: 38315111 DOI: 10.1177/21925682241230926] [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] [Indexed: 02/07/2024] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVES To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. METHODS Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. RESULTS 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. CONCLUSIONS Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.
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Affiliation(s)
- Arnaav Walia
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Fares Ani
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Tina Raman
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla Fischer
- NYU Langone Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Guo W, Li T, Feng C, Yu Y, Hu Y, Fan X. Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up. J Orthop Surg Res 2023; 18:943. [PMID: 38066527 PMCID: PMC10709901 DOI: 10.1186/s13018-023-04401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). METHODS The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. RESULTS The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05). CONCLUSIONS Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.
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Affiliation(s)
- Wenlong Guo
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China.
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
| | - Tong Li
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Chaoqun Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yang Yu
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Youpeng Hu
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xiaohong Fan
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610000, China
- Department of Orthopaedics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
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Akosman I, Lovecchio F, Fourman M, Sarmiento M, Lyons K, Memtsoudis S, Kim HJ. Is High-Dose Tranexamic Safe in Spine Surgery? A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:2085-2095. [PMID: 36592635 PMCID: PMC10556905 DOI: 10.1177/21925682221148686] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
STUDY DESIGN Literature review and meta-analysis. OBJECTIVES Single-center series may be underpowered to detect whether high-dose (HD) tranexamic acid (TXA) confers a higher risk of complications. We sought to determine the safety and efficacy of HD TXA as compared to low-dose (LD) or placebo. METHODS A systematic literature review was performed to find studies where spine surgery patients were given HD TXA (loading dose ≥30 mg/kg). Complication rates were pooled, and meta-analyses performed on outcomes of interest. Articles were evaluated for risk of bias and a strength of evidence assessment was given for each conclusion. RESULTS Twenty three studies (n = 2331) were included. The pooled medical complication rate was 3.2% in pediatric patients, 8.2% in adults. Using lower dose TXA or placebo as the reference, meta-analysis showed no difference in medical complications (n = 1,723, OR 1.22 [95% CI, .78 to 1.22]; P = .388; I2 = 0%) or thrombotic events (n = 1158 patients, OR 1.27 [95% CI, .71 to 2.63]; P = .528; I2 = 0%). Compared to LD, HD TXA was associated with less intraoperative blood loss (823 patients, WMD = -285 [95% CI, -564 to -5.90]; P = .0454; I2 = 86%), fewer perioperative transfusions (n = 505, OR .28 [95% CI, .082 to .96]; P = .043; I2 = 76%) and lower perioperative transfusion volumes (n = 434, WMD -227.7 mL [95% CI, -377.3 to -78.02]; P = .0029; I2 = 0%). CONCLUSION Compared to LD TXA or placebo, there is moderate evidence that HD is not associated with an increased risk of medical complications. Compared to LD, there is moderate evidence that HD reduces transfusion requirements. High-Dose TXA can be safely utilized in healthy patients undergoing major spine surgery.
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Affiliation(s)
| | - Francis Lovecchio
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Mitchell Fourman
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Manuel Sarmiento
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Keith Lyons
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
| | - Stavros Memtsoudis
- Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Spine Service, Hospital for Special Surgery, New York, NY, USA
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Chen Y, Zhou Y, Chen J, Luo Y, Wang Y, Fan X. A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery. BMC Surg 2023; 23:192. [PMID: 37407952 DOI: 10.1186/s12893-023-02082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Considering the high reoperation rate in degenerative lumbar spondylolisthesis (DLS) patients undergoing lumbar surgeries and controversial results on the risk factors for the reoperation, we performed a systematic review and meta-analysis to explore the reoperation rate and risk factors for the reoperation in DLS patients undergoing lumbar surgeries. METHODS Literature search was conducted from inception to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Odds ratio (OR) was used as the effect index for the categorical data, and effect size was expressed as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and subgroup analysis was performed based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Results of all outcomes were examined by sensitivity analysis. Publication bias was assessed using Begg test, and adjusted using trim-and-fill analysis. RESULTS A total of 39 cohort studies (27 retrospective cohort studies and 12 prospective cohort studies) were finally included in this systematic review and meta-analysis. The overall results showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients undergoing lumbar surgeries. In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) for decompression, 10% (95%CI: 7%-12%) for fusion, and 9% (95%CI: 5%-13%) for decompression and fusion. An increased risk of reoperation was found in patients with obesity (OR = 1.91, 95%CI: 1.04-3.51), diabetes (OR = 2.01, 95%CI: 1.43-2.82), and smoking (OR = 1.51, 95%CI: 1.23-1.84). CONCLUSIONS We found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were risk factors for the reoperation.
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Affiliation(s)
- Yuzhou Chen
- Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P.R. China
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Jinniu District, Chengdu, 610075, P.R. China
| | - Yi Zhou
- Department of Traditional Chinese Medicine, The Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu, 611130, P.R. China
| | - Junlong Chen
- Department of Anorectal, The Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu, 611130, P.R. China
| | - Yiping Luo
- Department of Gynecology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, P.R. China
| | - Yongtao Wang
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Jinniu District, Chengdu, 610075, P.R. China
| | - Xiaohong Fan
- Department of Orthopedics, Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-Er-Qiao Road, Jinniu District, Chengdu, 610075, P.R. China.
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Sastry RA, Chen JS, Shao B, Weil RJ, Chang KE, Maynard K, Syed SH, Zadnik Sullivan PL, Camara JQ, Niu T, Sampath P, Telfeian AE, Oyelese AA, Fridley JS, Gokaslan ZL. Patterns in Decompression and Fusion Procedures for Patients With Lumbar Stenosis After Major Clinical Trial Results, 2016 to 2019. JAMA Netw Open 2023; 6:e2326357. [PMID: 37523184 PMCID: PMC10391306 DOI: 10.1001/jamanetworkopen.2023.26357] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Use of lumbar fusion has increased substantially over the last 2 decades. For patients with lumbar stenosis and degenerative spondylolisthesis, 2 landmark prospective randomized clinical trials (RCTs) published in the New England Journal of Medicine in 2016 did not find clear evidence in favor of decompression with fusion over decompression alone in this population. Objective To assess the national use of decompression with fusion vs decompression alone for the surgical treatment of lumbar stenosis and degenerative spondylolisthesis from 2016 to 2019. Design, Setting, and Participants This retrospective cohort study included 121 745 hospitalized adult patients (aged ≥18 years) undergoing 1-level decompression alone or decompression with fusion for the management of lumbar stenosis and degenerative spondylolisthesis from January 1, 2016, to December 31, 2019. All data were obtained from the National Inpatient Sample (NIS). Analyses were conducted, reviewed, or updated on June 9, 2023. Main Outcome and Measure The primary outcome of this study was the use of decompression with fusion vs decompression alone. For the secondary outcome, multivariable logistic regression analysis was used to evaluate factors associated with the decision to perform decompression with fusion vs decompression alone. Results Among 121 745 eligible hospitalized patients (mean age, 65.2 years [95% CI, 65.0-65.4 years]; 96 645 of 117 640 [82.2%] non-Hispanic White) with lumbar stenosis and degenerative spondylolisthesis, 21 230 (17.4%) underwent decompression alone, and 100 515 (82.6%) underwent decompression with fusion. The proportion of patients undergoing decompression alone decreased from 2016 (7625 of 23 405 [32.6%]) to 2019 (3560 of 37 215 [9.6%]), whereas the proportion of patients undergoing decompression with fusion increased over the same period (from 15 780 of 23 405 [67.4%] in 2016 to 33 655 of 37 215 [90.4%] in 2019). In univariable analysis, patients undergoing decompression alone differed significantly from those undergoing decompression with fusion with regard to age (mean, 68.6 years [95% CI, 68.2-68.9 years] vs 64.5 years [95% CI, 64.3-64.7 years]; P < .001), insurance status (eg, Medicare: 13 725 of 21 205 [64.7%] vs 53 320 of 100 420 [53.1%]; P < .001), All Patient Refined Diagnosis Related Group risk of death (eg, minor risk: 16 900 [79.6%] vs 83 730 [83.3%]; P < .001), and hospital region of the country (eg, South: 7030 [33.1%] vs 38 905 [38.7%]; Midwest: 4470 [21.1%] vs 23 360 [23.2%]; P < .001 for both comparisons). In multivariable logistic regression analysis, older age (adjusted odds ratio [AOR], 0.96 per year; 95% CI, 0.95-0.96 per year), year after 2016 (AOR, 1.76 per year; 95% CI, 1.69-1.85 per year), self-pay insurance status (AOR, 0.59; 95% CI, 0.36-0.95), medium hospital size (AOR, 0.77; 95% CI, 0.67-0.89), large hospital size (AOR, 0.76; 95% CI, 0.67-0.86), and highest median income quartile by patient residence zip code (AOR, 0.79; 95% CI, 0.70-0.89) were associated with lower odds of undergoing decompression with fusion. Conversely, hospital region in the Midwest (AOR, 1.34; 95% CI, 1.14-1.57) or South (AOR, 1.32; 95% CI, 1.14-1.54) was associated with higher odds of undergoing decompression with fusion. Decompression with fusion vs decompression alone was associated with longer length of stay (mean, 2.96 days [95% CI, 2.92-3.01 days] vs 2.55 days [95% CI, 2.49-2.62 days]; P < .001), higher total admission costs (mean, $30 288 [95% CI, $29 386-$31 189] vs $16 190 [95% CI, $15 189-$17 191]; P < .001), and higher total admission charges (mean, $121 892 [95% CI, $119 566-$124 219] vs $82 197 [95% CI, $79 745-$84 648]; P < .001). Conclusions and Relevance In this cohort study, despite 2 prospective RCTs that demonstrated the noninferiority of decompression alone compared with decompression with fusion, use of decompression with fusion relative to decompression alone increased from 2016 to 2019. A variety of patient- and hospital-level factors were associated with surgical procedure choice. These results suggest the findings of 2 major RCTs have not yet produced changes in surgical practice patterns and deserve renewed focus.
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Affiliation(s)
- Rahul A Sastry
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jia-Shu Chen
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Belinda Shao
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Robert J Weil
- Department of Neurosurgery, Brain and Spine, Southcoast Health, Dartmouth, Massachusetts
| | - Ki-Eun Chang
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ken Maynard
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Sohail H Syed
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Patricia L Zadnik Sullivan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Joaquin Q Camara
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Tianyi Niu
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Prakash Sampath
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Adetokunbo A Oyelese
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Jared S Fridley
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Ziya L Gokaslan
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island
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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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Li Y, Cheng X, Chen B. Comparison of 270-degree percutaneous transforaminal endoscopic decompression under local anesthesia and minimally invasive transforaminal lumbar interbody fusion in the treatment of geriatric lateral recess stenosis associated with degenerative lumbar spondylolisthesis. J Orthop Surg Res 2023; 18:183. [PMID: 36895012 PMCID: PMC9996849 DOI: 10.1186/s13018-023-03676-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE Various lumbar decompression techniques have been used for the treatment of degenerative lumbar spondylolisthesis (DLS). Few studies have compared the clinical efficacy of percutaneous transforaminal endoscopic decompression (PTED) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lateral recess stenosis associated with DLS (LRS-DLS) in geriatric patients. The objective of the study was to compare the safety and short-term clinical efficacy of 270-degree PTED under local anesthesia and MIS-TLIF in the treatment of LRS-DLS in Chinese geriatric patients over 60 years old. MATERIALS AND METHODS From January 2017 to August 2019, the data of 90 consecutive geriatric patients with single-level L4-5 LRS-DLS were retrospectively reviewed, including those in the PTED group (n = 44) and MIS-TLIF group (n = 46). The patients were followed up for at least 1 year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. X-ray examinations were performed 1 year after surgery to assess the progression of spondylolisthesis in the PTED group and bone fusion in the MIS-TLIF group. RESULTS The mean patient ages in the PTED and MIS-TLIF groups were 70.3 years and 68.6 years, respectively. Both the PTED and MIS-TLIF groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time point (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the PTED group was similar to that in the MIS-TLIF group (90.9% vs. 91.3%, P > 0.05), PTED was advantageous in terms of the operative time, estimated blood loss, incision length, drainage time, drainage volume, length of hospital stay, and complications. CONCLUSIONS Both PTED and MIS-TLIF led to favorable outcomes in geriatric patients with LRS-DLS. In addition, PTED caused less severe trauma and fewer complications. In terms of perioperative quality-of-life and clinical outcomes, PTED could supplement MIS-TLIF in geriatric patients with LRS-DLS.
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Affiliation(s)
- Yubo Li
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China
| | - Xiaokang Cheng
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.,Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Bin Chen
- Department of Minimally Invasive Spine Surgery, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei, China.
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Xue Y, Li S, Wang Y, Zhang H, Cheng L, Wu Y, Wang Q, Wang D, Zou T, Shen J. Unilateral Modified Posterior Lumbar Interbody Fusion Combined With Contralateral Lamina Fenestration Treating Severe Lumbarspinal Stenosis: A Retrospective Clinical Study. Surg Innov 2023; 30:73-83. [PMID: 35505578 DOI: 10.1177/15533506221096016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Study design: Retrospective study. Objectives: The traditional PLIF is routinely utilized in severe lumbar spinal stenosis to relief the nerve compression. Nevertheless, the removal of posterior tension-band structure and the denervation and atrophy of the paraspinal muscle affect the clinical efficacy. Therefore, unilateral modified PLIF combined with contralateral fenestration was performed to overcome above-mentioned drawbacks. Methods: 32 modified PLIF and 33 traditional PLIF cases were retrospectively included. Operation time, length of stay (LOS) and blood loss were recorded. VAS of low back pain and leg pain, ODI and Sf-36 score including physical function and body pain were assessed. Fusion rate, lumbar lordosis (LL), intervertebral angle (IVA) and intervertebral height index (IHI) were evaluated radiologically. Results: Modified group possessed less blood loss, shorter operation time and less LOS. Compared with traditional group, the VAS of back pain was lower at 6 months postoperatively (P < .05) and the ODI score was lower at 3 months postoperatively (P < .05) in modified group. Modified group exhibited better physical function 3 months postoperatively and lower body pain 6 months postoperatively in Sf-36 score (P < .05). No statistic difference in LL, IVA, IHI and fusion rate were observed between both groups. Conclusions: Our modified PLIF combining with contralateral fenestration procedure exhibited particular advantages in comparison to traditional PLIF. The preservation of posterior tension-band structure facilitates to less low back pain, low complication rate and early functional recovery.
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Affiliation(s)
- Yulun Xue
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China.,Department of Orthopeadic Surgery, Changshu Second People's Hospital, the Affiliated Changshu Hospital of Xuzhou Medical University, the Fifth Hospital Affiliated to Yangzhou University, Changshu, China
| | - Suoyuan Li
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Yefeng Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Hong Zhang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Liang Cheng
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Yinghui Wu
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Qiang Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Donglai Wang
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Tianming Zou
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
| | - Jun Shen
- Department of Orthopeadic Surgery, the Affiliated Suzhou Hospital of Nanjing Medical University, Gusu School, Nanjing Medical University, 117958Suzhou Municipal Hospital, Suzhou, China
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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: 23] [Impact Index Per Article: 11.5] [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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13
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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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14
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Resnick DK, Schmidt BT. Update on Spinal Fusion. Neurol Clin 2022; 40:261-268. [DOI: 10.1016/j.ncl.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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