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World Neurosurg. 2018 Jun;114:e1275-e1283. doi: 10.1016/j.wneu.2018.03.196. Epub 2018 Apr 5.

Does Preoperative Degenerative Spondylolisthesis Influence Outcome in Degenerative Lumbar Spinal Stenosis? Three-Year Results of a Swiss Prospective Multicenter Cohort Study.

Author information

1
Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland; Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland. Electronic address: nils.hb.ulrich@gmail.com.
2
Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
3
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
4
Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland; Division of General Internal Medicine, Bern University Hospital, Bern University, Bern, Switzerland.
5
Spine Division, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
6
Department of Orthopedics and Neurosurgery, Spine Center, Schulthess Clinic, Zurich, Switzerland.

Abstract

BACKGROUND:

Decompression alone to treat degenerative lumbar stenosis with and without concomitant degenerative spondylolisthesis (DS; non-DS) has shown ambiguous results in the literature.

OBJECTIVE:

The aim is to compare clinical outcomes in DS and non-DS patients with lumbar stenosis who underwent decompression alone surgery without fusion on 1-3 adjacent levels after 6-month, 12-month, 24-month, and 36-month follow-up.

METHODS:

We conducted a prospective cohort study at 8 medical centers. The main outcomes of this study are changes in Spinal Stenosis Measure (SSM) symptoms score, SSM function score, and quality of life (EQ-5D-3L sum score) over time. Propensity score matching for DS versus non-DS was applied.

RESULTS:

One hundred seventy-seven patients met the inclusion criteria, 68 of whom had DS. In the matched cohort (n = 136), the estimated difference in SSM symptoms score of DS versus non-DS for changes from baseline to 36 months was 0.21 (95% CI, -0.15 to 0.57). For SSM function score, the estimated difference from baseline to 36 months was 0.05 (-0.21 to 0.31). Differences in changes between groups in EQ-5D-3L sum score were estimated to be -3.66 (-10.63 to 3.31) from baseline to 36 months. None of the group differences between the non-DS and the DS group was statistically significant. All matched patients improved over time in all additional outcomes.

CONCLUSIONS:

Even after 3 years of follow-up, we show that among patients with degenerative lumbar spinal stenosis, both groups (DS and non-DS) distinctively take advantage of decompression alone without fusion.

KEYWORDS:

Decompression; Degenerative spondylolisthesis; Fusion; Outcome; Spinal canal stenosis

PMID:
29626686
DOI:
10.1016/j.wneu.2018.03.196
[Indexed for MEDLINE]

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