Spinal fusion for lumbar stenosis: 11 takeaways from 2 studies


Two studies analyzed whether spinal fusion in combination with decompression surgery benefited lumbar stenosis patients, according to Medscape.

Sweden-based Uppsala University's Swedish Spinal Stenosis Study included 247 patients with lumbar spine stenosis at one or two adjacent vertebral levels. The researchers investigated whether the combination of fusion and decompression resulted in better clinical outcomes at two years post-surgery, compared to just decompression surgery.


New England Journal of Medicine published the study in its April 14 issue.


Here are six takeaways from the first study:


1. Adding fusion did not improve Oswestry Disability Index scores at two years and five years post-surgery.


2. The mean ODI at two years for the fusion patients was 27, compared to 24 in the decompression-alone group.


3. Those with degenerative spondylolisthesis demonstrated no disability score improvement with fusion.


4. Fusion patients experienced greater hospital stays, with 7.4 days versus 4.1 days.


5. Fusion with decompression increased costs but did not enhance outcomes, including walking distance.


6. Researchers concluded spinal fusion plus decompression surgery does not produce added benefits for patients or leave them less disabled.


The second study involved Burlington, Mass.-based Lahey Hospital and Medical Center researchers analyzing whether lumbar laminectomy with instrumented fusion would benefit patients more than laminectomy alone.


The study involved 66 patients with lumbar spinal stenosis and degenerative spondylolisthesis. Researchers divided the group into decompressive laminectomy or laminectomy with posterolateral instrumented fusion.


Here are five observations from the second study:


1. The change in ODI at two years for the fusion patients was -26.3, compared to -17.9 in the decompression-alone group.


2. The SF-36 at two years post-surgery increased by 15.2 for the fusion group and 9.5 for the decompression-alone group.


3. Fusion patients experienced greater hospital stays, with 4.2 days versus 2.6 days.


4. Mean blood loss was 513.7 mL for the fusion patients versus 83.4 mL for decompression-alone patients.


5. Researchers concluded instrumented fusion did not add value for patients.


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