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This article discusses lumbar fusion surgery following lumbar laminectomy for the treatment of degenerative lumbar spinal spondylolisthesis. The study aimed to identify the rate and risk factors of fusion surgery after laminectomy. The researchers reviewed data from a national database and included 33,681 patients who underwent lumbar laminectomy for stable degenerative spondylolisthesis. They found that 2.48% of patients required lumbar fusion surgery within 2 years after the initial operation. Several risk factors were identified, including diabetes, rheumatoid arthritis, clinical presentation with lower back pain and lower extremity weakness, and postoperative neurological complications. The findings of this study can guide clinicians in shared decision-making and help identify patients at higher risk for fusion surgery, potentially leading to preventive interventions
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spinal clinic in UK
Published article
CONCLUSION: In this large cross-sectional sample of a national claims database consisting of lumbar laminectomy patients for the treatment of spondylolisthesis, approximately 2.5 % required subsequent lumbar fusion. Several modifiable risk factors for fusion progression were identified, which may guide clinicians in shared decision-making and to help identify patients with elevated post-operative risk providing potential leverage point for prevention.
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Clin Neurol Neurosurg. 2023 Jul 31;233:107919. doi: 10.1016/j.clineuro.2023.107919. Online ahead of print.ABSTRACTOBJECTIVE: Lumbar laminectomy is often utilized in the treatment of degenerative lumbar spondylolisthesis. Risk factors that contribute to reoperation rates, in particular to progression to fusion, are poorly understood. We aimed to identify rate and risk factors of lumbar fusion surgery following lumbar laminectomy,
Clin Neurol Neurosurg. 2023 Jul 31;233:107919. doi: 10.1016/j.clineuro.2023.107919. Online ahead of print.
ABSTRACT
OBJECTIVE: Lumbar laminectomy is often utilized in the treatment of degenerative lumbar spondylolisthesis. Risk factors that contribute to reoperation rates, in particular to progression to fusion, are poorly understood. We aimed to identify rate and risk factors of lumbar fusion surgery following lumbar laminectomy for the treatment of degenerative lumbar spinal spondylolisthesis.
METHODS: Our sample was obtained from the national MarketScan Commercial Claims and Encounters Database. We reviewed patients undergoing lumbar laminectomy for stable degenerative lumbar spondylolisthesis (Grade-1) at one or two levels between January 2007 and December 2016.
RESULTS: A total of 33,681 patients were included. By 2 years after the index operation, 2.48 % of patients had required lumbar fusion surgery. Female sex was associated with lower odds (OR 0.8, 95 %CI 0.7-0.9) of reoperation for fusion. Diabetes (OR 1.2, 95 %CI 1.1-1.4), rheumatoid arthritis (OR 1.5, 95 %CI 1.2-1.7) and clinical presentation with LBP (OR 2.1, 95 %CI 1.6-2.9), lower extremity weakness (OR 1.4, 95 %CI 1.1-1.5), as well as occurrence of a postoperative neurological complications (OR 2.0, 95 %CI 1.1-3.4) increased the odds ratio for requiring fusion surgery within two years after lumbar laminectomy.
CONCLUSION: In this large cross-sectional sample of a national claims database consisting of lumbar laminectomy patients for the treatment of spondylolisthesis, approximately 2.5 % required subsequent lumbar fusion. Several modifiable risk factors for fusion progression were identified, which may guide clinicians in shared decision-making and to help identify patients with elevated post-operative risk providing potential leverage point for prevention.
PMID:37536253 | DOI:10.1016/j.clineuro.2023.107919
The London Spine Unit : most experienced spinal clinic in UK
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Progression to fusion after lumbar laminectomy for degenerative lumbar spondylolisthesis: Rate and risk-factors. A national database study
