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Swespine data show no benefit to addition of fusion to decompression for lumbar spinal stenosis

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SCOTTSDALE, Ariz. — A large study of Swedish patients with lumbar spinal stenosis indicates that the addition of fusion to decompression does not improve patient-reported outcomes at 2-year follow-up.

“In this study, the addition of fusion did not favor the outcome compared to decompression only, and this was regardless of if degenerative olisthesis was present preoperative or not,” Peter Försth, MD, said at the International Society for the Study of the Lumbar Spine Meeting, here.

 

Peter Försth

Försth and colleagues used the National Swedish Register for Spine Surgery to identify 5,390 patients with 2-year follow-up who had a diagnosis of lumbar spinal stenosis and underwent decompression on one or two adjacent levels between L2 and L5 with or without concomitant fusion. Of these patients, 1,177 underwent decompression and fusion. Analysis of baseline data revealed that more patients in the fusion group were women, had olisthesis and more back pain.

At 2 years, Försth said both treatment groups showed significant improvement compared to baseline scores for all outcome measurements including the Oswestry Disability Index, EQ-5D, back pain, leg pain, satisfaction and walking ability. The investigators also found no significant differences for these measures between the treatment groups, even when preoperative olisthesis was present.

“Whether fusion was done with instruments or [was] not instrumented, did not influence the results,” Försth said.

The reoperation rate for lumbar spinal stenosis was 8.1% in the fusion group and 7% in the decompression group, according to the study abstract. The mean time to the second operation was 37 months, Försth said.

“Decompression of the neuro elements seems to be the most important factor for the outcome, and its important to consider that fusion in this level of patients is associated with an increased risk of major complications and fatality compared with decompression only,” he said.

Reference:

Försth P. Paper #31. Presented at: The International Society for the Study of the Lumbar Spine Meeting. May 13-17, 2013; Scottsdale, Ariz.

Disclosure: Försth has no relevant financial disclosures.