Surgical versus nonsurgical treatment of lumbar degenerative kyphosis
- First Online:
- 169 Downloads
Surgery is widely performed for lumbar degenerative kyphosis (LDK), but its effectiveness as compared with nonsurgical treatment has not been demonstrated.
In this prospective study, surgical candidates with LDK were enrolled at three spine centres. Two treatment options were performed either surgery using a pedicle subtraction osteotomy or nonsurgical care. Outcomes were measured using a Visual analogue scale (VAS) of back pain as a primary endpoint, the Oswestry disability index (ODI), the 36-item short-form health survey (SF-36), sagittal vertical axis (SVA) and treatment-related complications.
Of the 126 LDK patients treated during the reference period, 97 patients were enrolled (47 in the surgical group and 50 in the nonsurgical group). Surgical group produced statistically reduced VAS of back pain and better functional outcomes than nonsurgical group since 12 months after treatment, but the rate of serious complications was higher after surgery. Interestingly, both surgical and nonsurgical groups had improved outcomes in terms of pain intensity and function at the 2-year follow-up period.
Surgery might be a preferred treatment option for LDK, but great caution is needed. And conservative treatment could be the considerable treatment option for LDK who is unwilling or has poor medical condition to operate.
KeywordsLumbar degenerative kyphosis Surgery Conservative Pedicle subtraction osteotomy Nonsurgical
- 5.Jang JS, Lee SH, Kim JM, Min JH, Han KM, Maeng DH (2009) Can patients with sagittally well-compensated lumbar degenerative kyphosis benefit from surgical treatment for intractable back pain? Neurosurgery 64:115–121. doi:10.1227/01.neu.0000335642.14527.26 (discussion 121) CrossRefPubMedGoogle Scholar
- 10.Kuittinen P, Sipola P, Leinonen V, Saari T, Sinikallio S, Savolainen S, Kroger H, Turunen V, Airaksinen O, Aalto T (2014) Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis. PLoS One 9:e106404. doi:10.1371/journal.pone.0106404 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Crawford CH 3rd, Glassman SD, Mummaneni PV, Knightly JJ, Asher AL (2016) Back pain improvement after decompression without fusion or stabilization in patients with lumbar spinal stenosis and clinically significant preoperative back pain. J Neurosurg Spine 25:596–601. doi:10.3171/2016.3.spine151468 CrossRefPubMedGoogle Scholar
- 19.Kuwahara W, Deie M, Fujita N, Tanaka N, Nakanishi K, Sunagawa T, Asaeda M, Nakamura H, Kono Y, Ochi M (2016) Characteristics of thoracic and lumbar movements during gait in lumbar spinal stenosis patients before and after decompression surgery. Clin Biomech (Bristol, Avon) 40:45–51. doi:10.1016/j.clinbiomech.2016.10.016 CrossRefGoogle Scholar