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Interlaminar stabilization a sustainable treatment for vertebral motion segment after decompression
According to the results of a recently published study, interlaminar stabilization may provide improved clinical outcomes, safety and radiographic outcomes at 48 months postoperatively compared with posterolateral fusion with pedicle screw fixation after decompression for spinal stenosis.
Researchers conducted retrospective analysis of data generated from a prospective, randomized, level-one trial to compare the outcomes of interlaminar stabilization (ILS) with posterolateral fusion in patients after decompression for spinal stenosis. Randomization was performed at a 2:1 ratio, with 230 patients undergoing ILS and 114 patients undergoing fusion between 2006 and 2010 at 21 sites.
The researchers defined success as no secondary surgeries and an Oswestry Disability Index score improvement of 15 or more points. Of the patients studied, 57.6% who underwent ILS were declared a success compared with 46.7% of patients who underwent fusion.
According to the researchers, the addition of lack of fusion to the ILS cohort and successful fusion in the fusion cohort demonstrated composite clinical success (CCS) rates of 42.7% and 33.3%, respectively. When adjacent-level success was added to both cohorts and foraminal height maintenance was added in the coflex cohort, CSS rates of 36.6% and 25.6% were observed.
Overall, adverse event rates were considered similar between the two groups, but patients who underwent fusion were found to have a higher incidence of events that were deemed definitely or probably related to the implant (20.6% vs. 14.9%), according to the researchers. Additionally, severe adverse events occurred in 8.8% of the ILS cohort and 15% of the fusion population during the 48-month period.
The researchers concluded, when considering factors associated with longer-term therapeutic sustainability and durability, ILS appeared to be superior to fusion. Further data also showed patients experienced an average cost savings of $11,681 during a 5-year period when compared with fusion, according to the researchers. – by Robert Linnehan
Disclosures: Bae reports receiving research support for clinical trials from Paradigm Spine. Please see the full study for a list of all other authors’ relevant financial disclosures.