Decompression alone vs. decompression plus fusion for claudication secondary to lumbar spinal stenosis

Kenneth Thomas, Peter Faris, Greg McIntosh, Simon Manners, Edward Abraham, Christopher S. Bailey, Jerome Paquet, David Cadotte, W. Bradley Jacobs, Y. Raja Rampersaud, Neil A. Manson, Hamilton Hall, Charles G. Fisher

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)

Abstract

BACKGROUND: Degenerative lumbar spinal stenosis is a common condition, predominantly affecting middle-aged and elderly people. This study focused on patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity. PURPOSE: To determine whether the addition of fusion to decompression resulted in improved clinical outcomes at 3, 12, and 24 months postsurgery. STUDY DESIGN/SETTING: The Canadian Spine Outcomes and Research Network (CSORN) prospective database that includes pre- and postoperative data from tertiary care hospitals. PATIENT SAMPLE: The CSORN database was queried for consecutive spine surgery cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Neurogenic claudication patients with baseline and 2-year follow-up data, from four sites, formed the study sample (n=306). The sample was categorized into two groups: (1) those that had decompression alone, and (2) those that underwent decompression plus fusion. OUTCOME MEASURES: Change in modified Oswestry Disability Index (ODI), numerical rating scale for back/leg pain, the EuroQol EQ5D, the SF-12 physical, and mental component scores. The primary outcome measure was the ODI at 2 years postoperative. METHODS: We conducted a multicenter, ambispective review of consecutive spine surgery patients enrolled between October 2012 and January 2018. RESULTS: Baseline characteristics were comparable between groups except for female sex and multilevel pathology (both with greater proportion in the decompression plus fusion group). The decompression plus fusion group had clinically meaningfully more operative time, blood loss, rate of perioperative complication, and length of hospital stay (p<.05). These differences were preserved following adjustment for baseline differences between the groups. Both decompression and decompression plus fusion had a large clinically meaningful impact on generic and disease-specific patient-reported outcome measures within 3 months of surgery which was maintained out to 24-month follow-up. At any follow-up time point, there was no statistical evidence of a difference in these effects favoring decompression plus fusion over decompression alone. CONCLUSIONS: The addition of fusion to decompression did not result in improved outcomes at 3-, 12-, or 24-month follow-up. The addition of fusion to decompression provides no advantage to decompression alone for the treatment of patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity.

Original languageEnglish
Pages (from-to)1633-1639
Number of pages7
JournalSpine Journal
Volume19
Issue number10
DOIs
Publication statusPublished - Oct 2019

Bibliographical note

Funding Information:
The authors thank all of the subjects who participated in the study and the support/research coordinator staff and investigators from the Canadian Spine Outcomes and Research Network (CSORN) contributing sites:, Foothills Medical Centre: Calgary AB; Canada East Spine Centre: Saint John NB; Hospital de L'enfant Jesus: Quebec City QC; Victoria Hospital - London Health Sciences Centre: London ON.

Publisher Copyright:
© 2019 Elsevier Inc.

ASJC Scopus Subject Areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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