TY - JOUR
T1 - Lumbar fusion for degenerative disease
T2 - A systematic review and meta-analysis
AU - Yavin, Daniel
AU - Casha, Steven
AU - Wiebe, Samuel
AU - Feasby, Thomas E.
AU - Clark, Callie
AU - Isaacs, Albert
AU - Holroyd-Leduc, Jayna
AU - Hurlbert, R. John
AU - Quan, Hude
AU - Nataraj, Andrew
AU - Sutherland, Garnette R.
AU - Jette, Nathalie
AU - Whitmore, Robert G.
N1 - Publisher Copyright:
© Copyright 2017 by the Congress of Neurological Surgeons.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - BACKGROUND: Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE: To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS: AsystematicreviewwasconductedusingPubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS: The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION: Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
AB - BACKGROUND: Due to uncertain evidence, lumbar fusion for degenerative indications is associated with the greatest measured practice variation of any surgical procedure. OBJECTIVE: To summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, or nonoperative care for degenerative indications. METHODS: AsystematicreviewwasconductedusingPubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (up to June 30, 2016). Comparative studies reporting validated measures of safety or efficacy were included. Treatment effects were calculated through DerSimonian and Laird random effects models. RESULTS: The literature search yielded 65 studies (19 randomized controlled trials, 16 prospective cohort studies, 15 retrospective cohort studies, and 15 registries) enrolling a total of 302 620 patients. Disability, pain, and patient satisfaction following fusion, decompression-alone, or nonoperative care were dependent on surgical indications and study methodology. Relative to decompression-alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR 0.75, 95% CI 0.68-0.83). Among patients with spinal stenosis, complications were more frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not significantly associated with any treatment modality. CONCLUSION: Positive clinical change was greatest in patients undergoing fusion for spondylolisthesis while complications and the risk of reoperation limited the benefit of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggests careful patient selection is required (PROSPERO International Prospective Register of Systematic Reviews number, CRD42015020153).
KW - Decompression
KW - Fusion
KW - Low back pain
KW - Lumbar spondylosis
KW - Meta-analysis
KW - Spinal stenosis
KW - Spondylolisthesis
UR - http://www.scopus.com/inward/record.url?scp=85015796754&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyw162
DO - 10.1093/neuros/nyw162
M3 - Review article
C2 - 28327997
AN - SCOPUS:85015796754
SN - 0148-396X
VL - 80
SP - 701
EP - 715
JO - Neurosurgery
JF - Neurosurgery
IS - 5
ER -