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Spine (Phila Pa 1976). 2018 Dec 1;43(23):1619-1630. doi: 10.1097/BRS.0000000000002682.

Long-Term Results of Surgery Compared With Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis in the Spine Patient Outcomes Research Trial (SPORT).

Author information

1
Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.
2
Department of Orthopaedics, Dartmouth College, Hanover, New Hampshire.
3
Department of Medicine, Dartmouth College, Hanover, New Hampshire.
4
The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, New Hampshire.

Abstract

STUDY DESIGN:

Randomized trial with a concurrent observational cohort study.

OBJECTIVE:

To compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS).

SUMMARY OF BACKGROUND DATA:

Surgical treatment of DS has been shown to be more effective than nonoperative treatment out to 4 years. This study sought to further determine the long-term (8-year) outcomes.

METHODS:

Surgical candidates with DS from 13 centers with at least 12 weeks of symptoms and confirmatory imaging were offered enrollment in a randomized controlled trial (RCT) or observational cohort study (OBS). Treatment consisted of standard decompressive laminectomy (with or without fusion) versus standard nonoperative care. Primary outcome measures were the Short Form-36 (SF-36) bodily pain and physical function scores and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and yearly up to 8 years.

RESULTS:

Data were obtained for 69% of the randomized cohort and 57% of the observational cohort at the 8-year follow up. Intent-to-treat analyses of the randomized group were limited by high levels of nonadherence to the randomized treatment. As-treated analyses in the randomized and observational groups showed significantly greater improvement in the surgery group on all primary outcome measures at all time points through 8 years. Outcomes were similar among patients treated with uninstrumented posterolateral fusion, instrumented posterolateral fusion, and 360° fusion.

CONCLUSION:

For patients with symptomatic DS, patients who received surgery had significantly greater improvements in pain and function compared with nonoperative treatment through 8 years of follow-up. Fusion technique did not affect outcomes.

LEVEL OF EVIDENCE:

1.

PMID:
29652786
PMCID:
PMC6185822
[Available on 2019-12-01]
DOI:
10.1097/BRS.0000000000002682
[Indexed for MEDLINE]

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