Y Raja Rampersaud1, Charles Fisher2, Albert Yee3, Marcel F Dvorak2, Joel Finkelstein3, Eugene Wai4, Edward Abraham5, Stephen J Lewis1, David Alexander6, William Oxner6. 1. The Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, and the Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital University Health Network, University of Toronto, Toronto, Ont. 2. The Combined Neurosurgical and Orthopaedic Spine Program (CNOSP), Department of Orthopaedics, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, BC. 3. The Sunnybrook Health Sciences Centre, Toronto, Ont. 4. The Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, and the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. 5. The Atlantic Health Science Corporation, St. John, NB. 6. The Dalhousie University, QEII Health Sciences Centre, Halifax, NS.
Abstract
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.
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.
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