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Muthu S, Ćorluka S, Buser Z, Malcolm JG, Luo Z, Gollahalli Shivashankar P, Ambrosio L, Griffoni C, Demetriades AK, Ivandić S, Wu Y, Wang J, Meisel HJ, Yoon TS. Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis: A Systematic Review of Literature. JB JS Open Access 2024; 9:e23.00163. [PMID: 38974406 PMCID: PMC11221853 DOI: 10.2106/jbjs.oa.23.00163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Management of lumbar degenerative spondylolisthesis with decompression-only procedure has been performed for its added benefit of a shorter duration of surgery, lower blood loss, and shorter hospital stay. However, reported failure rates for decompression-only procedures vary depending on the methods utilized for decompression. Hence, we aim to identify the failure rates of individual methods of decompression-only procedures performed for degenerative lumbar spondylolisthesis. Methods An independent systematic review of 4 scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis guidelines. Studies reporting on failure rates defined by reoperation at the index level following decompression-only procedure for degenerative lumbar spondylolisthesis were included for analysis. Studies were appraised using ROBINS tool of Cochrane, and analysis was performed using the Open Meta[Analyst] software. Results The overall failure rate of decompression-only procedure was 9.1% (95% confidence interval [CI] [6.5-11.7]). Furthermore, open decompression had failure rate of 10.9% (95% CI [6.0-15.8]), while microendoscopic decompression had failure rate of 6.7% (95% CI [2.9-10.6]). The failure rate gradually increased from 6.9% (95% CI [2.0-11.7]) at 1 year to 7% (95% CI [3.6-10.3]), 11.7% (95% CI [4.5-18.9]), and 11.7% (95% CI [6.6-16.7]) at 2, 3, and 5 years, respectively. Single level decompression had a failure rate of 9.6% (95% CI [6.3-12.9]), while multilevel decompression recorded a failure rate of 8.7% (95% CI [5.6-11.7]). Conclusion High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1% without significant differences between the decompression techniques. Level of Evidence Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sathish Muthu
- Department of Spine Surgery, Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Faculty of Engineering, Department of Biotechnology, Karpagam Academy of Higher Education, Coimbatore, Tamil Nadu, India
- Department of Orthopaedics, Government Medical College, Karur, Tamil Nadu, India
| | - Stipe Ćorluka
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
- Department of Anatomy and Physiology, University of Applied Health Sciences, Zagreb, Croatia
| | - Zorica Buser
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, New York
| | | | - Zhuojing Luo
- Department of Orthopeadic Surgery, Xijing Hospital, China
| | | | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Italy
| | - Cristiana Griffoni
- Department of Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andreas K. Demetriades
- Department of Neurosurgery, Edinburgh Spinal Surgery Outcome Studies Group, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Stjepan Ivandić
- Spinal Surgery Division, Traumatology Department, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Yabin Wu
- Research Department, AO Spine, AO Foundation, Davos, Switzerland
| | - Jeffrey Wang
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Hans-Jorg Meisel
- Department of Neurosurgery, Bergmannstrost Hospital, Halle, Germany
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Ko S, Choi W. Usefulness of preoperative Short Form-36 Mental Component Score as a prognostic factor in patients who underwent decompression surgery for degenerative lumbar spinal stenosis. Medicine (Baltimore) 2022; 101:e30231. [PMID: 36181126 PMCID: PMC9524984 DOI: 10.1097/md.0000000000030231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Physical factors such as frequency of low back pain, sensory abnormalities in the lower extremities, smoking history before surgery, and preoperative mental health status as predictors of operative outcomes have been growing as areas of interest in the field of degenerative lumbar spinal stenosis (DLSS). This study aimed to investigate the correlation between the preoperative Short Form-36 Mental Component Score (SF-36 MCS) and long-term prognosis after decompression surgery for DLSS. In total, 198 patients were enrolled in this study. The Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ) were used to evaluate spinal functional outcomes. The SF-36 questionnaire was used and analyzed by classifying it into physical component score (PCS) and mental component score (MCS). The SF-36 MCS was divided into role limitations caused by emotional problems, social functioning, vitality, and emotional well-being. In the correlation between preoperative MCS and ODI improvement, the r value was -0.595 (P < .05) at 12 months postoperatively. ODI improvement at 12 months after decompression surgery showed a statistically significant and strong negative correlation with preoperative MCS. In the correlation between preoperative MCS and RMDQ improvement, the r value was -0.544 (P < .05) at 12 months postoperatively. Therefore, RMDQ improvement 12 months after decompression surgery showed a strong negative correlation with preoperative MCS. Regarding the correlation between preoperative MCS and SF-36 PCS improvement, the r values were 0.321 (P < .05) at 6 months postoperatively and 0.343 (P < .05) at 12 months postoperatively. Therefore, SF-36 PCS improvement at 6 and 12 months after decompression surgery showed a strong positive correlation with preoperative SF-36 MCS scores. Preoperative SF-36 MCS is a factor that can predict the prognosis of patients who underwent decompression surgery for lumbar spinal stenosis for at least 1 year postoperatively.
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Affiliation(s)
- Sangbong Ko
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Korea
- *Correspondence: Sangbong Ko MD, PhD, Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, 42472] 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, Korea (e-mail: )
| | - Wonkee Choi
- Department of Orthopaedic Surgery, School of Medicine, Daegu Catholic University Hospital, Daegu, Korea
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Roh YH, Lee JC, Hwang J, Cho HK, Soh J, Choi SW, Shin BJ. Long-Term Clinical and Radiological Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion: 10-Year Follow-up Results. J Korean Med Sci 2022; 37:e105. [PMID: 35380029 PMCID: PMC8980361 DOI: 10.3346/jkms.2022.37.e105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/10/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Many studies have reported that minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) provides satisfactory treatment comparable to other fusion methods. However, in the case of MI-TLIF, there are concerns about the long-term outcome compared to conventional bilateral PLIF due to the small amount of disc removal and the lack of autogenous bone graft. Long-term follow-up studies are still lacking as most of the previous reports have follow-up periods of up to 5 years. METHODS Thirty patients who underwent MI-TLIF were followed up for > 10 years (mean, 11.1 years). Interbody fusion rates were determined using a modified Bridwell grading system. Adjacent segment disease (ASD) was defined as radiological adjacent segment degeneration (R-ASDeg) as seen on plain X-rays; reoperated adjacent segment disease referred to the subsequent need for revision surgery. Clinical outcomes after surgery were assessed based on back and leg pain as well as the Oswestry disability index (ODI). RESULTS The overall radiological fusion rate, at the 1-, 5-, and 10-year follow-up was 77.1%, 91.4%, and 94.3%, respectively. The incidence of R-ASDeg 1, 5, and 10 years after surgery was 6.7%, 16.7%, and 43.3% at the proximal adjacent segment and 4.8%, 14.3%, and 28.6% at the distal adjacent segment, respectively. R-ASDeg at either the proximal or distal segment was determined in 50.0% of the patients 10 years postoperatively. All clinical parameters improved significantly during follow-up, although the ODI and the visual analog scale (VAS) for leg pain at the 10-year follow-up were significantly worse in the R-ASDeg group than in the other patients (P = 0.009, P = 0.040). CONCLUSION MI-TLIF improved both clinical and radiological outcomes, and the improvements were maintained for up to 10 years after surgery. However, R-ASDeg developed in up to 50% of the patients within 10 years, and both leg pain on the VAS and the ODI were worse in patients with R-ASDeg.
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Affiliation(s)
- Young-Ho Roh
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
| | - Jinyeong Hwang
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyung-Ki Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jaewan Soh
- Department of Orthopaedic Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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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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Roh YH, Lee JC, Cho HK, Jang HD, Choi SW, Shin BJ. Comparative Study of Radiological and Clinical Outcomes in Patients Undergoing Minimally Invasive Lateral Lumbar Interbody Fusion Using Demineralized Bone Matrix Alone or with Low-Dose Escherichia coli-Derived rhBMP-2. World Neurosurg 2021; 158:e557-e565. [PMID: 34775087 DOI: 10.1016/j.wneu.2021.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare the results of interbody fusion in patients undergoing minimally invasive lateral lumbar interbody fusion (LLIF) using demineralized bone matrix (DBM) alone versus DBM+recombinant human bone morphogenetic protein-2 (rhBMP2). METHODS This retrospective case-controlled study was conducted in patients undergoing minimally invasive LLIF (n = 54) for lumbar interbody fusion; they were divided into 2 groups: DBM-only group and DMB+rhBMP2 group. The improvements of segmental and lumbar lordosis and restoration of disc height were measured, and the interbody fusion rates were determined using a modified Bridwell grading system. Clinical outcomes after surgery, such as visual analog scale scores of back pain and leg pain, and Oswestry disability index were compared. RESULTS There were no significant differences in disc height, lumbar and segmental lordosis, or interbody fusion rate between the 2 groups. However, the proportion of Bridwell grade 1 as complete interbody bridging was higher in the DBM+rhBMP2 group than in the DBM-only group at both 6 and 12 months (P < 0.001). Clinical parameters showed equally significant improvement during follow-up in both groups, with no significant differences between the groups. CONCLUSION In minimally invasive LLIF, adding Escherichia coli-derived rhBMP2 to DBM did not affect clinical outcomes or radiation parameters, but increased the speed of fusion and interbody bony bridging rate.
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Affiliation(s)
- Young-Ho Roh
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju-si, Jeju-do, Republic of Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea.
| | - Hyung-Ki Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Yongsan-gu, Seoul, Republic of Korea
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Son HJ, Choi SH, Heo DR, Kook I, Lee MK, Ahn HS, Kang CN. Outcomes of the use of cement-augmented cannulated pedicle screws in lumbar spinal fusion. Spine J 2021; 21:1857-1865. [PMID: 33992795 DOI: 10.1016/j.spinee.2021.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT There are few studies of the radio-clinical outcomes of cement-augmented cannulated pedicle screw (CPS) fixation in osteoporotic patients. PURPOSE To compare the radiological and clinical outcomes between groups receiving cement-augmented CPS and solid pedicle screws (SPS) in lumbar fusion surgery. STUDY DESIGN/SETTING Retrospective comparative study PATIENT SAMPLE: A total of 187 patients who underwent lumbar fusion surgery for degenerative spinal stenosis or spondylolisthesis from 2014 to 2019. OUTCOME MEASURES Radiological evaluation included screw failure, cage failure, rod breakage, and fusion grade at postoperative 6 months and 1 year. Pre- and postoperative visual analog scales for back pain (VAS-BP), leg pain (VAS-LP), Korean Oswestry disability index (K-ODI), and postoperative complications were also compared. METHODS Outcomes of patients with high risk factors for implant failure [old age, osteoporosis, autoimmune disease or chronic kidney disease (CKD)] who underwent open transforaminal lumbar interbody fusion with cement-augmented CPS fixation (Group C, n=55) or SPS fixation (Group S, n=132) were compared. RESULTS 324 pedicle screws in Group C and 775 pedicle screws in Group S were analyzed. Group C had a significantly higher average age and lower T-score, and included more patients with autoimmune disease and CKD than group S (all p<.05). Clear zones, screw migration and loss of correction were significantly less frequent in Group C (all p<.05). Thirteen screw breakages were observed; they were only in Group C (4.0%) and all were in the proximal of the two holes. Interbody and posterolateral fusion rates were not significantly different. At last follow-up, all clinical parameters including VAS-BP, VAS-LP, and K-ODI scores had improved significantly in both groups. Postoperative complications were not significantly different in the two groups. CONCLUSION In lumbar fusion surgery, using cement-augmented CPS in high-risk groups for implant failure could be a useful technical option for reducing acute radiological complications and obtaining clinical results comparable to those obtained using SPS in patients with low risk of implant failure. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Hee Jung Son
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Dong Ryul Heo
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Incheol Kook
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Myoung Keun Lee
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyung Seob Ahn
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Chang-Nam Kang
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
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The Relationship between Adjacent Segment Pathology and Facet Joint Violation by Pedicle Screw after Posterior Lumbar Instrumentation Surgery. J Clin Med 2021; 10:jcm10132911. [PMID: 34209877 PMCID: PMC8267951 DOI: 10.3390/jcm10132911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/20/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
Transpedicular screw instrumentation systems have been increasingly utilized during the fusion of lumbar spine procedures. The superior segment facet joint violation of the pedicle screw is thought to have potential for accelerating symptomatic adjacent-segment pathology (ASP). The purpose of this study was to investigate the relationship between the superior segment facet joint violation by transpedicular screws and the development of ASP. Among all patients who underwent operations involving one- or two-level posterior lumbar arthrodesis at the Chonnam National University Hospital from 1992 to 2012, 87 patients were selected for this study. Fifty-six patients were included in the ASP group, and 31 were included in the non-ASP group. We used lumbar three-dimensional computed tomography (CT) to assess the violation of the superior facet joint by a transpedicular screw. The assessment is presented in scores ranging from zero to two, with zero indicating no violation (type I); one point indicating suspected violation (type II); and two points indicating definitely facet joint violation (type III). Facet violation was reported in 31 patients in the ASP group (n = 56), and in 13 patients in the non-ASP group (n = 31). The types of facet joint violation according to our scoring system were as follows: type I, 59 screws (52.7%); type II, 26 screws (23.2%); and type III, 27 screws (24.1%) in the ASP group; and type I, 43 screws (69.4%), type II, 14 screws (22.6 %); and type III, 5 screws (8.0%) in the non-ASP group. The score of facet joint violation in each patient according to our scoring system were as follows: 0 points, 25 patients (44.6%); 1 point, 8 patients (14.3%); 2 points, 4 patients (7.1%); 3 points, 11 patients (19.7%); 4 points, 8 patients (14.3%) in the ASP group; and 0 points, 18 patients (58.1%); 1 point, 4 patients (12.9%); 2 points, 7 patients (22.6%); 3 points, 2 patients (6.4%); 4 points, 0 patients (0%) in the non-ASP group. The mean scores were 1.4 points in the ASP group and 0.8 points in the non-ASP group (p < 0.05). We conclude that the position of the pedicle screw farther away from the facet joint surface can reduce the degeneration of the superior adjacent segment. Therefore, close attention to the screw position during surgery may reduce the rate of superior adjacent-segment pathologies.
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