Kenneth Thomas1, Peter Faris1, Greg McIntosh2, Simon Manners3, Edward Abraham4, Christopher S Bailey5, Jerome Paquet6, David Cadotte1, W Bradley Jacobs1, Y Raja Rampersaud7, Neil A Manson4, Hamilton Hall8, Charles G Fisher9. 1. University of Calgary, Foothills Medical Centre, 1403 29th ST NW, Calgary, Alberta, Canada T2N 2T9. 2. Canadian Spine Outcomes and Research Network, 10 Armstrong Cres PO Box 1053, Markdale, Ontario, Canada N0C 1H0. Electronic address: gmcintosh@spinecanada.ca. 3. Middlemore Hospital Orthopaedic Department, 100 Hospital Rd, Otahuhu, Auckland 2025, New Zealand. 4. Dalhousie University, Halifax, Nova Scotia, Canada B3H 4R2; Canada East Spine Centre, 555 Somerset St, Suite 200, Saint John, New Brunswick, Canada E2K 4 × 2. 5. London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd. E., E1-317, London, Ontario, Canada N6A 5W9; Schulich School of Medicine, Western University, London, Ontario, Canada. 6. Division of Neurosurgery, Department of Surgery, CHU de Québec-Université Laval, 1401 18e rue Québec City, Québec, Canada G1J 1Z4. 7. Toronto Western Hospital, 399 Bathurst Street, East Wing 1 - 441, Toronto, Ontario, Canada M5T 2S8; University of Toronto, 494851 Traverston Road, Markdale, Ontario, Canada N0C 1H0; University Health Network, Toronto, Ontario, Canada; Arthritis Program, Krembil Research Institute, Toronto, Ontario, Canada. 8. University of Toronto, 494851 Traverston Road, Markdale, Ontario, Canada N0C 1H0. 9. Vancouver General Hospital, University of British Columbia, Blusson Spinal Cord Center, 6th floor, 818 West 10th Avenue, Vancouver, British Columbia, Canada V5Z 1M9.
Abstract
BACKGROUND: Degenerative lumbar spinal stenosis is a common condition, predominantly affecting middle-aged and elderly people. This study focused on patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity. PURPOSE: To determine whether the addition of fusion to decompression resulted in improved clinical outcomes at 3, 12, and 24 months postsurgery. STUDY DESIGN/ SETTING: The Canadian Spine Outcomes and Research Network (CSORN) prospective database that includes pre- and postoperative data from tertiary care hospitals. PATIENT SAMPLE: The CSORN database was queried for consecutive spine surgery cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Neurogenic claudication patients with baseline and 2-year follow-up data, from four sites, formed the study sample (n=306). The sample was categorized into two groups: (1) those that had decompression alone, and (2) those that underwent decompression plus fusion. OUTCOME MEASURES: Change in modified Oswestry Disability Index (ODI), numerical rating scale for back/leg pain, the EuroQol EQ5D, the SF-12 physical, and mental component scores. The primary outcome measure was the ODI at 2 years postoperative. METHODS: We conducted a multicenter, ambispective review of consecutive spine surgery patients enrolled between October 2012 and January 2018. RESULTS: Baseline characteristics were comparable between groups except for female sex and multilevel pathology (both with greater proportion in the decompression plus fusion group). The decompression plus fusion group had clinically meaningfully more operative time, blood loss, rate of perioperative complication, and length of hospital stay (p<.05). These differences were preserved following adjustment for baseline differences between the groups. Both decompression and decompression plus fusion had a large clinically meaningful impact on generic and disease-specific patient-reported outcome measures within 3 months of surgery which was maintained out to 24-month follow-up. At any follow-up time point, there was no statistical evidence of a difference in these effects favoring decompression plus fusion over decompression alone. CONCLUSIONS: The addition of fusion to decompression did not result in improved outcomes at 3-, 12-, or 24-month follow-up. The addition of fusion to decompression provides no advantage to decompression alone for the treatment of patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity.
BACKGROUND: Degenerative lumbar spinal stenosis is a common condition, predominantly affecting middle-aged and elderly people. This study focused on patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity. PURPOSE: To determine whether the addition of fusion to decompression resulted in improved clinical outcomes at 3, 12, and 24 months postsurgery. STUDY DESIGN/ SETTING: The Canadian Spine Outcomes and Research Network (CSORN) prospective database that includes pre- and postoperative data from tertiary care hospitals. PATIENT SAMPLE: The CSORN database was queried for consecutive spine surgery cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Neurogenic claudicationpatients with baseline and 2-year follow-up data, from four sites, formed the study sample (n=306). The sample was categorized into two groups: (1) those that had decompression alone, and (2) those that underwent decompression plus fusion. OUTCOME MEASURES: Change in modified Oswestry Disability Index (ODI), numerical rating scale for back/leg pain, the EuroQol EQ5D, the SF-12 physical, and mental component scores. The primary outcome measure was the ODI at 2 years postoperative. METHODS: We conducted a multicenter, ambispective review of consecutive spine surgery patients enrolled between October 2012 and January 2018. RESULTS: Baseline characteristics were comparable between groups except for female sex and multilevel pathology (both with greater proportion in the decompression plus fusion group). The decompression plus fusion group had clinically meaningfully more operative time, blood loss, rate of perioperative complication, and length of hospital stay (p<.05). These differences were preserved following adjustment for baseline differences between the groups. Both decompression and decompression plus fusion had a large clinically meaningful impact on generic and disease-specific patient-reported outcome measures within 3 months of surgery which was maintained out to 24-month follow-up. At any follow-up time point, there was no statistical evidence of a difference in these effects favoring decompression plus fusion over decompression alone. CONCLUSIONS: The addition of fusion to decompression did not result in improved outcomes at 3-, 12-, or 24-month follow-up. The addition of fusion to decompression provides no advantage to decompression alone for the treatment of patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity.