| Popis: |
BACKGROUND CONTEXT Controversy exists regarding whether fusion should be used to augment decompression surgery in patients with symptomatic lumbar spinal stenosis with grade I/II (low-grade), stable degenerative spondylolisthesis. For years, the standard has been fusion with laminectomy in order to prevent postoperative instability. However, instability and reoperations may be reduced or prevented using less invasive, structure sparing decompression techniques without the need for fusion. PURPOSE To compare reoperation rates within a 5-year follow-up period of unilateral laminotomy for bilateral decompression (ULBD) versus posterior lumbar decompression with instrumented fusion (fusion) for patients with degenerative spondylolisthesis with spinal stenosis in a multicenter database. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A final cohort of 601 Kaiser Permanente Northern California members with diagnoses of lumbar degenerative spondylolisthesis and lumbar spinal stenosis of whom 164 patients underwent ULBD and 437 underwent fusion between January 2007 and December 2011. OUTCOME MEASURES The primary outcome measure was reoperation rate at 5-year postoperative follow-up. Secondary outcome measures included blood loss during surgery, length of stay, reoperation type, reoperation level, and 90-day postoperative complication rates. METHODS We identified 164 patients with lumbar degenerative spondylolisthesis and lumbar stenosis who underwent ULBD between January 2007 and December 2011. These patients were propensity score matched on age at surgery, gender, race and smoking status with patients who underwent fusion (n=437). The primary outcome was 5-year reoperation rate and secondary outcome measures included postoperative complication rates, reoperation type, reoperation level, blood loss during surgery, and length of stay. RESULTS The reoperation rate within 5-year follow-up was significantly lower at 10.4% in the ULBD group compared to 17.2% in the fusion group (p=.0393). Type of reoperation was similar between the two groups. Reoperation at the index or adjacent level was not significant different between the two groups. Patients that underwent ULBD had significantly less mean estimated blood loss compared to fusion (82 vs. 445 ml, p CONCLUSIONS For patients with stable degenerative spondylolisthesis and lumbar stenosis, ULBD is a viable, durable option compared to fusion with a lower reoperation rate within a 5-year follow-up period, as well as decreased blood loss and length of stay. Further prospective studies are required to determine the optimal clinical scenario for ULBD in the setting of degenerative spondylolisthesis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs |
Full Text from ScienceDirect