The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study

Ekman, Per; Möller, Hans; Hedlund, Rune

doi:10.1016/j.spinee.2004.05.249

Cited by 117 publications

(74 citation statements)

References 22 publications

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“…As previously reported for pain, DRI, ODI and Global outcome [11], no significant differences in any radiological variable could be demonstrated between patients operated on with or without instrumentation. The posterior disc height reduction was 6.6% of anterior vertebral height in the instrumented group compared to 6.5% in the noninstrumented group (ns).…”

Section: Subgroup Analysis: Instrumentation Vs No Instrumentationsupporting

confidence: 72%

“…We have earlier shown a slight deterioration of the outcome 9 years after lumbar fusion in this group of patients [11]. One could speculate that the reason for this decline in outcome for the fused patients is the development of ASD.…”

Section: Discussionmentioning

confidence: 53%

“…The average follow-up time was 12.6 years (range [10][11][12][13][14][15][16][17]. The mean age at the start of the study was 39 years and at the end of the study was 52 years.…”

Section: Radiographic Analysismentioning

confidence: 99%

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A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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The existence and importance of an accelerated adjacent segment disc degeneration (ASD) after lumbar fusion have previously not been demonstrated by RCTs. The objectives of this study were, to determine whether lumbar fusion in the long term accelerates degenerative changes in the adjacent disc and whether this affects the outcome, by using a prospective randomised design. A total of 111 patients, aged 18-55, with isthmic spondylolisthesis were randomised to exercise (EX, n = 34) or posterolateral fusion (PLF, n = 77), with (n = 37) or without pedicle screw instrumentation (n = 40). The minimum 10 years FU rate was 72%, with a mean FU time of 12.6 years (range 10-17 years). Three radiographic methods of ASD quantification were used, i.e. two digital radiographic measurement methods and the semi quantitative UCLA grading scale. One digital measurement method showed a mean disc height reduction by 2% in the EX group and by 15% in the PLF group (p = 0.0016), and the other showed 0.5 mm more disc height reduction in the PLF compared to the Ex group (ns). The UCLA grading scale showed normal discs in 100% of patients in the EX group, compared to 62% in the PLF group (p = 0.026). There were no significant differences between instrumented and non-instrumented patients. In patients with laminectomy we found a significantly higher incidence of ASD compared to non laminectomised patients (22/47 vs. 2/16 respectively, p = 0.015). In the longitudinal analysis, the posterior and anterior disc heights were significantly reduced in the PLF group, whereas in the EX group only the posterior disc height was significantly reduced. Except for global outcome, which was significantly better for patients without ASD, the clinical outcome was not statistically different in patients with and without ASD. In conclusion, the long-term RCT shows that fusion accelerates degenerative changes at the adjacent level compared with natural history. The study suggests that not only fusion, but also laminectomy may be of pathogenetic importance. The clinical importance of ASD seems limited, with only the more severe forms affecting the outcome.

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Section: Subgroup Analysis: Instrumentation Vs No Instrumentationsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 53%

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A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

et al. 2009

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“…Only 3.8 % of patients would refuse to have the fusion operation if they were offered the option again. In RCT studies, patient satisfaction was about 70 % when followed up after about 10 years [18,19]. Half of the patients followed up had no radicular pain and their daily use of analgesics had reduced to half the original amount.…”

Section: Discussionmentioning

confidence: 99%

“…In a randomized controlled trial focusing on instrumented and noninstrumented fusions, Andersen et al [18] found that 71 % of patients in both groups were still satisfied after 11-13 years. Similarly, a randomized study conducted by Ekman et al [19] indicated that 76 % of fusion patients with adult isthmic spondylolisthesis were still satisfied 9 years after the operation. Ekman also stated that fusion seemed to accelerate degenerative changes in adjacent segments, albeit generally without clinical significance, compared with the control group when followed up after 12.5 years [20].…”

Section: Introductionmentioning

confidence: 88%

Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11–13 years

et al. 2012

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Introduction and materials We examined lumbar transpedicular instrumented posterolateral fusion patients operated on between 1992 and 1997 presenting: degenerative spondylolisthesis with spinal stenosis; adult isthmic spondylolisthesis; failed back syndrome after one to five discectomies; and failed back syndrome after one to three laminectomy operations (Groups 1-4, respectively). Methods They were examined by an independent orthopedic surgeon, completed the Oswestry Disability Index (ODI) and visual analog scale (VAS) questionnaires and their outcome was evaluated. Results The overall patient satisfaction at follow-up (mean 11.7 years) was 82.1 %. The reoperation rate was 15.1 % (7.5 % due to adjacent segment disease).Conclusion Group 1 showed the greatest improvements in ODI and VAS values, Group 2 the lowest and Group 3 the highest preoperative values, and Group 4 the second highest improvements. Patient satisfaction scores were 90.3, 69.7, 63.6 and 80.0 %, respectively, and unplanned reoperation rates were 6.5, 9.1, 31.8 and 20.0 %. Thus, long-term outcomes of lumbar instrumented posterolateral fusion (rarely previously studied) were satisfactory for [80 % of patients, but varied among groups.

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Minimally Invasive Transforaminal Lumbar Interbody Fusion

Ogden

Fessler

2009

Minimally Invasive Surgery in Orthopedics

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The long-term effect of posterolateral fusion in adult isthmic spondylolisthesis: a randomized controlled study

Cited by 117 publications

References 22 publications

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration

Lumbar instrumented posterolateral fusion in spondylolisthetic and failed back patients: a long-term follow-up study spanning 11–13 years

Minimally Invasive Transforaminal Lumbar Interbody Fusion

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