Lumbar Fusion for Degenerative Illness: A Systematic Assessment and Meta-Evaluation.
Neurosurgery. 2017 Could 01;80(5):701-715
Authors: Yavin D, Casha S, Wiebe S, Feasby TE, Clark C, Isaacs A, Holroyd-Leduc J, Hurlbert RJ, Quan H, Nataraj A, Sutherland GR, Jette N
BACKGROUND: Attributable to unsure proof, lumbar fusion for degenerative indications is related to the best measured apply variation of any surgical process.
OBJECTIVE: To summarize the present proof on the comparative security and efficacy of lumbar fusion, decompression-alone, or nonoperative look after degenerative indications.
METHODS: A scientific assessment was carried out utilizing PubMed, MEDLINE, EMBASE, and the Cochrane Central Register of Managed Trials (as much as June 30, 2016). Comparative research reporting validated measures of security or efficacy had been included. Remedy results had been calculated by DerSimonian and Laird random results fashions.
RESULTS: The literature search yielded 65 research (19 randomized managed trials, 16 potential cohort research, 15 retrospective cohort research, and 15 registries) enrolling a complete of 302 620 sufferers. Incapacity, ache, and affected person satisfaction following fusion, decompression-alone, or nonoperative care had been depending on surgical indications and examine methodology. Relative to decompression-alone, the chance of reoperation following fusion was elevated for spinal stenosis (relative threat [RR] 1.17, 95% confidence interval [CI] 1.06-1.28) and decreased for spondylolisthesis (RR Zero.75, 95% CI Zero.68-Zero.83). Amongst sufferers with spinal stenosis, issues had been extra frequent following fusion (RR 1.87, 95% CI 1.18-2.96). Mortality was not considerably related to any remedy modality.
CONCLUSION: Optimistic medical change was best in sufferers present process fusion for spondylolisthesis whereas issues and the chance of reoperation restricted the advantage of fusion for spinal stenosis. The relative security and efficacy of fusion for power low again ache suggests cautious affected person choice is required (PROSPERO Worldwide Potential Register of Systematic Opinions quantity, CRD42015020153).
PMID: 28327997 [PubMed – indexed for MEDLINE]