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Novel Mini-open Transforaminal Lumbar Interbody Fusion
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Lumbar Fusion for Degenerative Disease: A Systematic Review and Meta-Analysis
Daniel Yavin1,2, Steven Casha1,3, Samuel Wiebe2,3,4,5
1Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Canada.
Neurosurgery
|March 23, 2017
Summary
Lumbar fusion shows greatest benefit for spondylolisthesis but increased reoperation risk for spinal stenosis. Careful patient selection is crucial for optimizing outcomes in degenerative spine conditions.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Lumbar fusion for degenerative spine conditions has high practice variation due to uncertain evidence.
- Comparative safety and efficacy data for different treatment modalities are needed.
Purpose of the Study:
- To systematically review and summarize evidence on the comparative safety and efficacy of lumbar fusion, decompression-alone, and nonoperative care for degenerative indications.
- To analyze treatment effects based on specific surgical indications.
Main Methods:
- Systematic review of PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials up to June 2016.
- Inclusion of comparative studies with validated safety or efficacy measures.
- Random effects models used for calculating treatment effects.
Main Results:
- Analysis of 65 studies involving 302,620 patients.
- Fusion increased reoperation risk for spinal stenosis (RR 1.17) but decreased it for spondylolisthesis (RR 0.75).
- Higher complication rates observed with fusion for spinal stenosis (RR 1.87); no significant mortality difference across treatments.
Conclusions:
- Lumbar fusion yielded the greatest clinical improvement for spondylolisthesis.
- Complications and reoperation risks associated with fusion for spinal stenosis can limit its benefits.
- Careful patient selection is essential for maximizing the relative safety and efficacy of lumbar fusion for chronic low back pain.
