Cargando…

Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up

AIMS: The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two ye...

Descripción completa

Detalles Bibliográficos
Autores principales: Karlsson, Thomas, Försth, Peter, Skorpil, Mikael, Pazarlis, Konstantinos, Öhagen, Patrik, Michaëlsson, Karl, Sandén, Bengt
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The British Editorial Society of Bone & Joint Surgery 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680197/
https://www.ncbi.nlm.nih.gov/pubmed/36453045
http://dx.doi.org/10.1302/0301-620X.104B12.BJJ-2022-0340.R1
_version_ 1784834358286221312
author Karlsson, Thomas
Försth, Peter
Skorpil, Mikael
Pazarlis, Konstantinos
Öhagen, Patrik
Michaëlsson, Karl
Sandén, Bengt
author_facet Karlsson, Thomas
Försth, Peter
Skorpil, Mikael
Pazarlis, Konstantinos
Öhagen, Patrik
Michaëlsson, Karl
Sandén, Bengt
author_sort Karlsson, Thomas
collection PubMed
description AIMS: The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. METHODS: The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm(2) at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis). RESULTS: A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two-year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not. CONCLUSION: Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively. Cite this article: Bone Joint J 2022;104-B(12):1343–1351.
format Online
Article
Text
id pubmed-9680197
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher The British Editorial Society of Bone & Joint Surgery
record_format MEDLINE/PubMed
spelling pubmed-96801972022-12-01 Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up Karlsson, Thomas Försth, Peter Skorpil, Mikael Pazarlis, Konstantinos Öhagen, Patrik Michaëlsson, Karl Sandén, Bengt Bone Joint J Spine AIMS: The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion. METHODS: The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two-year MRI follow-up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two-year MRI was used as the primary outcome, defined as a dural sac cross-sectional area ≤ 75 mm(2) at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis). RESULTS: A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two-year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not. CONCLUSION: Adding fusion to a decompression increased the rate of new stenosis on two-year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively. Cite this article: Bone Joint J 2022;104-B(12):1343–1351. The British Editorial Society of Bone & Joint Surgery 2022-12-01 /pmc/articles/PMC9680197/ /pubmed/36453045 http://dx.doi.org/10.1302/0301-620X.104B12.BJJ-2022-0340.R1 Text en © 2022 Author(s) et al. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Spine
Karlsson, Thomas
Försth, Peter
Skorpil, Mikael
Pazarlis, Konstantinos
Öhagen, Patrik
Michaëlsson, Karl
Sandén, Bengt
Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title_full Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title_fullStr Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title_full_unstemmed Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title_short Decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year MRI follow-up
title_sort decompression alone or decompression with fusion for lumbar spinal stenosis: a randomized clinical trial with two-year mri follow-up
topic Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680197/
https://www.ncbi.nlm.nih.gov/pubmed/36453045
http://dx.doi.org/10.1302/0301-620X.104B12.BJJ-2022-0340.R1
work_keys_str_mv AT karlssonthomas decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT forsthpeter decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT skorpilmikael decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT pazarliskonstantinos decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT ohagenpatrik decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT michaelssonkarl decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup
AT sandenbengt decompressionaloneordecompressionwithfusionforlumbarspinalstenosisarandomizedclinicaltrialwithtwoyearmrifollowup