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Clinical Utility of An Intervertebral Motion Metric for Deciding on the Addition of Instrumented Fusion in Degenerative Spondylolisthesis – Lumbar Fusion

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This article is a summary of a prospective single-arm clinical study that explores the clinical utility of an intervertebral motion metric for surgical treatment plans in patients with lumbar spinal stenosis (LSS) from degenerative spondylolisthesis. The study aimed to determine the proportion of patients for whom the metric changed their surgical treatment plan from decompression only to decompression with fusion or vice versa. The metric, called the Sagittal Plane Shear Index (SPSI), was calculated based on flexion-extension radiographs. Results showed that 29% of participants had a change in their intended surgical plan after the SPSI metric was considered. This change exceeded the predefined threshold of 15% and suggests that the SPSI metric may be a useful adjunct in decision-making between different surgical procedures

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : finest spine hospital in the world

Published article

: The 29% change in intended surgical plans suggested that SPSI was considered by spine surgeons as an adjunct metric in deciding whether to perform decompression only or or to add instrumented fusion. This change exceeded the a priori defined 15% considered necessary to show potential clinical utility of SPSI.

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Spine (Phila Pa 1976). 2024 Jan 12. doi: 10.1097/BRS.0000000000004918. Online ahead of print.ABSTRACTSTUDY DESIGN: A prospective single-arm clinical study.OBJECTIVE: To explore the clinical utility of an intervertebral motion metric by determining the proportion of patients for whom it changed their surgical treatment plan from decompression only to decompression with fusion or vice versa.SUMMARY OF BACKGROUND,

Spine (Phila Pa 1976). 2024 Jan 12. doi: 10.1097/BRS.0000000000004918. Online ahead of print.

ABSTRACT

STUDY DESIGN: A prospective single-arm clinical study.

OBJECTIVE: To explore the clinical utility of an intervertebral motion metric by determining the proportion of patients for whom it changed their surgical treatment plan from decompression only to decompression with fusion or vice versa.

SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis (LSS) from degenerative spondylolisthesis is commonly treated with decompression only or decompression with additional instrumented fusion. An objective diagnostic tool capable of establishing abnormal motion between lumbar vertebrae to guide decision-making between surgical procedures is needed. To this end a metric, based on the vertebral sagittal plane translation-per-degree-of-rotation (TPDR) calculated from flexion-extension radiographs, was developed.

METHODS: First, spine surgeons documented their intended surgical plan. Subsequently, the participants’ flexion-extension radiographs were taken. From these the TPDR was calculated and reported as a Sagittal Plane Shear Index (SPSI). The SPSI metric of the spinal level intended to treat was used to decide if the intended surgical plan needed to be changed or not.

RESULTS: SPSI was determined for 75 participants. Of these, 51 (68%) had an intended surgical plan of decompression only and 24 (32%) decompression with fusion. In 63% of participants the SPSI was in support of their intended surgical plan. For 29% of participants the surgeon changed the surgical plan after the SPSI metric became available to them. A suggested change in surgical plan was overruled in 8% of participants. The final surgical plan was decompression only for 59 (79%) and decompression with fusion for 16 (21%) participants.

: The 29% change in intended surgical plans suggested that SPSI was considered by spine surgeons as an adjunct metric in deciding whether to perform decompression only or or to add instrumented fusion. This change exceeded the a priori defined 15% considered necessary to show potential clinical utility of SPSI.

PMID:38213123 | DOI:10.1097/BRS.0000000000004918

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Clinical Utility of An Intervertebral Motion Metric for Deciding on the Addition of Instrumented Fusion in Degenerative Spondylolisthesis

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Spine (Phila Pa 1976). 2024 Jan 12. doi: 10.1097/BRS.0000000000004918. Online ahead of print.ABSTRACTSTUDY DESIGN: A prospective single-arm clinical study.OBJECTIVE: To explore the clinical utility of an intervertebral motion metric by determining the proportion of patients for whom it changed their surgical treatment plan from decompression only to decompression with fusion or vice versa.SUMMARY OF BACKGROUND

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