To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?
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Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)].
213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D (N = 56) or D&F (N = 157) as the operative procedure. Pre-op and at 12 months’ follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0–10 leg-pain (LP) and LBP scales. At 12 months’ FU, patients rated global outcome which was then dichotomised into “good” and “poor”.
Pre-operatively, LBP and COMI scores were significantly worse (p < 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months’ FU was significantly greater for D&F than for D (p < 0.001) and was not influenced by the patient’s declared “main problem” at baseline (back pain, leg pain, or neurological disturbances) (p > 0.05). There was a higher proportion (p = 0.01) of “good” outcomes at 12 months’ FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome).
Our study indicated that LDS patients showed better patient-based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.
- Cummins J, Lurie JD, Tosteson TD, Hanscom B, Abdu WA, Birkmeyer NJ, Herkowitz H, Weinstein J (2006) Descriptive epidemiology and prior healthcare utilization of patients in the Spine Patient Outcomes Research Trial’s (SPORT) three observational cohorts: disc herniation, spinal stenosis, and degenerative spondylolisthesis. Spine (Phila Pa 1976) 31:806–814 CrossRef
- Epstein NE, Epstein JA, Carras R, Lavine LS (1983) Degenerative spondylolisthesis with an intact neural arch: a review of 60 cases with an analysis of clinical findings and the development of surgical management. Neurosurgery 13:555–561 CrossRef
- Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT (1997) 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976) 22:2807–2812 CrossRef
- Fox MW, Onofrio BM, Hanssen AD (1996) Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85:793–802 CrossRef
- Ghogawala Z, Benzel EC, Amin-Hanjani S, Barker FG 2nd, Harrington JF, Magge SN, Strugar J, Coumans JV, Borges LF (2004) Prospective outcomes evaluation after decompression with or without instrumented fusion for lumbar stenosis and degenerative Grade I spondylolisthesis. J Neurosurg Spine 1:267–272 CrossRef
- Jacobsen S, Sonne-Holm S, Rovsing H, Monrad H, Gebuhr P (2007) Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976) 32:120–125 CrossRef
- Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, costs, and surgical outcomes. Spine (Phila Pa 1976) 22:1123–1131 CrossRef
- Kelleher MO, Timlin M, Persaud O, Rampersaud YR (2010) Success and failure of minimally invasive decompression for focal lumbar spinal stenosis in patients with and without deformity. Spine (Phila Pa 1976) 35:E981–E987 CrossRef
- Kleinstuck FS, Fekete T, Jeszenszky D, Mannion AF, Grob D, Lattig F, Mutter U, Porchet F (2011)The outcome of decompression surgery for lumbar herniated disc is influenced by the level of concomitant pre-operative low back pain. Eur Spine J (in press)
- Kleinstuck FS, Grob D, Lattig F, Bartanusz V, Porchet F, Jeszenszky D, O’Riordan D, Mannion AF (2009) The influence of preoperative back pain on the outcome of lumbar decompression surgery. Spine (Phila Pa 1976) 34:1198–1203 CrossRef
- Kornblum MB, Fischgrund JS, Herkowitz HN, Abraham DA, Berkower DL, Ditkoff JS (2004) Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion and pseudarthrosis. Spine (Phila Pa 1976) 29:726–733 CrossRef
- Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14:1014–1026 CrossRef
- Mannion AF, Porchet F, Kleinstück F, Lattig F, Jeszenszky D, Bartanusz V, Dvorak J, Grob D (2009) The quality of spine surgery from the patient’s perspective: part 1. The Core Outcome Measures Index (COMI) in clinical practice. Eur Spine J 18:367–373 CrossRef
- Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK (2007) The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976) 32:1791–1798 CrossRef
- Matsudaira K, Yamazaki T, Seichi A, Takeshita K, Hoshi K, Kishimoto J, Nakamura K (2005) Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion. J Orthop Sci 10:270–276 CrossRef
- Okuda S, Oda T, Miyauchi A, Haku T, Yamamoto T, Iwasaki M (2007) Surgical outcomes of posterior lumbar interbody fusion in elderly patients. Surgical technique. J Bone Joint Surg Am 89(Suppl 2 Pt.2):310–320 CrossRef
- Pearson AM, Lurie JD, Blood EA, Frymoyer JW, Braeutigam H, An H, Girardi FP, Weinstein JN (2008) Spine patient outcomes research trial: radiographic predictors of clinical outcomes after operative or nonoperative treatment of degenerative spondylolisthesis. Spine (Phila Pa 1976) 33:2759–2766 CrossRef
- Postacchini F, Perugia D (1991) Degenerative lumbar spondylolisthesis. Part I: etiology, pathogenesis, pathomorphology, and clinical features. Ital J Orthop Traumatol 17:165–173
- Rousseau MA, Lazennec JY, Bass EC, Saillant G (2005) Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis. Eur Spine J 14:55–60 CrossRef
- Sansur CA, Reames DL, Smith JS, Hamilton DK, Berven SH, Broadstone PA, Choma TJ, Goytan MJ, Noordeen HH, Knapp DR, Hart RA, Zeller RD, Donaldson WF, Polly DW, Perra JH, Boachie-Adjei O, Shaffrey CI (2010) Morbidity and mortality in the surgical treatment of 10, 242 adults with spondylolisthesis. J Neurosurg Spine 13:589–593 CrossRef
- Satomi K, Hirabayashi K, Toyama Y, Fujimura Y (1992) A clinical study of degenerative spondylolisthesis. Radiographic analysis and choice of treatment. Spine (Phila Pa 1976) 17:1329–1336 CrossRef
- Sengupta DK, Herkowitz HN (2005) Degenerative spondylolisthesis: review of current trends and controversies. Spine (Phila Pa 1976) 30:S71–S81 CrossRef
- Toyoda H, Nakamura H, Konishi S, Dohzono S, Kato M, Matsuda H (2011) Clinical outcome of microsurgical bilateral decompression via unilateral approach for lumbar canal stenosis: minimum five-year follow-up. Spine (Phila Pa 1976) 36(5):410–415
- Wai EK, Howse K, Pollock JW, Dornan H, Vexler L, Dagenais S (2009) The reliability of determining “leg dominant pain”. Spine J 9:447–453 CrossRef
- Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270 CrossRef
- Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304 CrossRef
- Yone K, Sakou T, Kawauchi Y, Yamaguchi M, Yanase M (1996) Indication of fusion for lumbar spinal stenosis in elderly patients and its significance. Spine (Phila Pa 1976) 21:242–248 CrossRef
- To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?
European Spine Journal
Volume 21, Issue 2 , pp 268-275
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