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Reoperations After Decompression With or Without Fusion for L3-4 Spinal Stenosis With Degenerative Spondylolisthesis: A Study of 372 Patients in Swespine, the National Swedish Spine Register
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics.ORCID iD: 0000-0002-7931-9617
Örebro University, School of Medical Sciences. Department of Orthopedics.
Örebro University, School of Medical Sciences. Department of Orthopedics.ORCID iD: 0000-0002-3905-7210
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Orthopedics.ORCID iD: 0000-0002-7376-4664
2022 (English)In: Clinical spine surgery, E-ISSN 2380-0194, Vol. 35, no 3, p. E389-E393Article in journal (Refereed) Published
Abstract [en]

STUDY DESIGN: Register study with prospectively collected data.

OBJECTIVE: The aim was to investigate reoperation rates at the index level and the adjacent levels after surgery for lumbar L3-4 spinal stenosis with concomitant degenerative spondylolisthesis (DS).

SUMMARY OF BACKGROUND DATA: There are different opinions on how to surgically address lumbar spinal stenosis with DS. The potential benefit of fusion surgery should be weighed against the risks of future reoperations because of adjacent segment degeneration. Data on the reoperation rate at adjacent segments after single level L3-4 fusion surgery are limited.

MATERIALS AND METHODS: A total of 372 patients, who underwent surgery for lumbar L3-4 spinal stenosis with DS (slip >3 mm) between 2007 and 2012, were followed between 2007 and 2017 to identify reoperations at the index level and adjacent levels. The reoperation rate for decompression and fusion was compared with the reoperation rate for decompression only. Patient-reported outcome measures before and 1 year after surgery were evaluated.

RESULTS: The reoperation rate at the index level (L3-4) was 3.5% for decompression and fusion and 5.6% for decompression only. At the cranial adjacent level (L2-3), the corresponding numbers were 6.6% and 4.2%, respectively, and the caudal adjacent level (L4-5), the corresponding numbers were 3.1% and 4.9%, respectively. The effect sizes of change were larger for decompression and fusion compared with decompression only. The effect sizes of change were similar for leg pain and back pain.

CONCLUSIONS: We could not identify any differences in reoperation rates at the cranial or caudal adjacent segment after decompression and fusion compared with decompression only for L3-4 spinal stenosis with DS. The improvement in back pain is similar to the improvement in leg pain after surgery for L3-4 spinal stenosis with DS.

Place, publisher, year, edition, pages
Wolters Kluwer, 2022. Vol. 35, no 3, p. E389-E393
Keywords [en]
adjacent segment disease, degenerative spondylolisthesis, reoperation rates, spinal stenosis, patient-reported outcome measures
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-94957DOI: 10.1097/BSD.0000000000001255ISI: 000771786800015PubMedID: 34629386Scopus ID: 2-s2.0-85117930972OAI: oai:DiVA.org:oru-94957DiVA, id: diva2:1602284
Available from: 2021-10-12 Created: 2021-10-12 Last updated: 2022-04-19Bibliographically approved

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Joelson, AndersNerelius, FredrikHoly, MarekSigmundsson, Freyr Gauti

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