Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

Abstract

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study Background: Decompression alone (D) is a well-accepted treatment for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication; however, D is controversial in patients with LSS who have degenerative spondylolisthesis (DLS). Our goal was to compare the outcome of anatomy-preserving D with decompression and fusion (DF) for patients with grade I DLS. We compared patients with DLS who had elective primary 1-2 level spinal D at 1 centre with a cohort who had 1-2 level spinal DF at 5 other centres. Methods:Patients followed for at least 2 years were included. Primary analysis included comparison of change in SF-36 physical component summary (PCS) scores and the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Results:There was no significant difference in baseline SF-36 scores between the groups. The average change in PCS score was 10.4 versus 11.4 (p = 0.61) for the D and DF groups, respectively. Sixty-seven percent of the D group and 71% of the DF group attained MCID, while 64% of both D and DF groups attained SCB. There was no significant difference between D and DF for change in PCS score (p = 0.74) or likelihood of reaching MCID (p = 0.81) or SCB (p = 0.85) after adjusting for other variables. Conclusion:In select patients with DLS, the outcome of D is comparable to DF at a minimum of 2 years.Contexte : La décompression seule est un traitement bien accepté pour la sténose lombaire (SL) causant une claudication neurogène. Son utilisation ne fait cependant pas l'unanimité chez les patients atteints de SL qui souffrent d'un spondylolisthésis dégénératif (SLD). Notre objectif était de comparer l'issue d'une décompression avec préservation anatomique à celle d'une décompression-arthrodèse (DA) chez des patients atteints de SLD de grade 1. Nous avons comparé les patients atteints de SLD ayant subi une décompression élective primaire de niveau 1-2 dans un centre à une cohorte ayant subi une DA de niveau 1-2 effectuée dans 5 autres centres.Méthodes : Nous avons inclus les patients qui ont été suivis pendant au moins 2 ans. L'analyse primaire comportait une comparaison des changements aux scores sommaires pour la composante physique (CP) du questionnaire SF-36 et la proportion de patients ayant obtenu une différence minimale cliniquement importante (DMCI) et en ayant tiré un bienfait clinique substantiel (BCS). Résultats :Il n'y avait pas de différence significative entre les scores SF-36 des 2 groupes au départ. Le changement moyen du score pour la CP a été de 10,4 c. 11,4 (p = 0,61) dans les groupes soumis à la décompression et à la DA, respectivement. Soixante-sept pour cent des patients du groupe soumis à la décompression et 71 % du groupe soumis à la DA ont obtenu une DMCI, tandis que 64 % des 2 groupes ont obtenu un BCS. On n'a noté aucune différence significative entr...

Decompression with or without concomitant fusion in lumbar stenosis due to degenerative spondylolisthesis: a systematic review

“…Matsudaira [26] and Plotz and Benini [27] obtained seven points and are, therefore, considered having a high risk of bias. Rampersaud et al [2], Forsth et al [3], Herkowitz and Kurz [5] and Ghogawala et al [7] scored a total of eight points; Park et al [28] and Sigmundsson et al [29] scored a total of nine points and Kleinstueck et al [12] a total of ten points. These studies thus have a medium risk of bias.…”

“…Two studies were prospective controlled cohort studies [5,26]. Seven of the studies were retrospective controlled cohort studies [2,3,7,12,[26][27][28][29].…”

“…In six studies, a laminectomy was performed [2,7,12,[25][26][27][28]. Two studies [2,26] used a decompression technique with preservation of midline structures and Forsth et al [24] used both techniques (laminectomy in 80% of the patients and a midline preserving technique in 20% of patients). The studies by Herkowitz and Kurz [5] and Ghogawala et al [25] described the use of a laminectomy and concomitant partial facetectomy.…”

“…Ghogawala et al [7], Kleinstueck et al [12], Park et al [28], Rampersaud [2] and Sigmundsson et al [29] performed a posterior lumbar interbody fusion (PLIF) and Kleinstueck et al [12] additionally used a transforaminal lumbar interbody fusion (TLIF) in a subgroup of patients. Four studies compared posterolateral fusion (PLF) with decompression alone [2,12,25,26]. Forsth et al [3] performed an instrumented fusion in 95% of the cases (5% was uninstrumented).…”

“…Back pain may coincide these complaints and can be attributed to the degenerative lumbar spine. Clinical symptoms vary amongst patients, but can have incapacitating effects on the patient's quality of life [2].…”