Fusion Doesn't Up Reoperation Risk With Spinal Stenosis
Duration of pretreatment symptoms is only factor predictive of re-op after spinal stenosis surgery
THURSDAY, April 11 (HealthDay News) -- For patients undergoing surgical treatment of spinal stenosis, lumbar fusion and instrumentation do not increase the rate of reoperation at index or adjacent levels compared with nonfusion techniques, according to a study published in the April 1 issue of Spine.
Kris Radcliff, M.D., from Thomas Jefferson University in Philadelphia, and colleagues examined whether lumbar fusion or patient-level characteristics correlate with reoperation at the index or adjacent levels using data from the combined randomized and observational cohorts enrolled in Spine Patient Outcomes Research Trial for treatment of spinal stenosis. Of the surgically treated patients 54 underwent reoperation and 359 had no reoperation. Patients were followed for four years.
The researchers found that there were no significant differences in demographic characteristics or clinical outcome scores between the groups at baseline. Severity of symptoms; obesity; levels, location, and severity of stenosis; levels of fusion, laminectomy, and decompression; operation time, and intraoperative or postoperative complications were all similar between the groups. In the reoperation group there was a significantly increased percentage of patients with duration of symptoms greater than 12 months (56 versus 36 percent in the no reoperation group). At the end of the study, in the reoperation group there was significantly less improvement in outcomes as measured by the Medical Outcomes Study 36-item Short-Form Health Survey physical function, the Oswestry Disability Index, and the Sciatica Bothersomeness Index.
"These results suggest reconsideration of the classical hypothesis of elevated rates of adjacent segment disease occurring due to lumbar fusion, because reoperations occurred after both decompressions and lumbar fusions," write the authors.
Abstract (http://journals.lww.com/spinejournal/Abstract/2013/04010/Risk_for_Adjacent_Segment_and_Same_Segment.2.aspx )Full Text (subscription or payment may be required) (http://journals.lww.com/spinejournal/Abstract/2013/04010/Risk_for_Adjacent_Segment_and_Same_Segment.2.aspx )