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Decompression and interlaminar stabilization may be a viable treatment for lumbar spinal stenosis
Researchers of this level 1 study found decompression and interlaminar stabilization used to treat patients with lumbar spinal stenosis offered similar 5-year outcomes, and even better earlier outcomes, compared with decompression and fusion.
Researchers included patients with moderate to severe lumbar stenosis at one or two contiguous levels and up to grade I spondylolisthesis. Patients were randomized (2:1) into either a decompression and interlaminar stabilization treatment group or a decompression and fusion group. In total, 215 patients were randomized into the decompression and interlaminar stabilization (D+ILS) group using the coflex Interlaminar Stabilization device (Paradigm Spine LLC) and 107 patients underwent decompression and fusion with pedicle screws (D+PS).
Researchers evaluated outcomes at several postoperative time points and at 5-years follow-up. Composite success criteria was determined as a greater than 15-point improvement in Oswestry Disability Index score, no reoperations or revision surgeries, no major device-related complications and no epidural steroid injections after surgery, according to the researchers.
At 5-year follow-up, 50.3% of D+ILS patients reached the composite success criteria compared with 44% of D+PS patients. Reoperation rates were similar in the groups, and both groups demonstrated a statistically significant improvement in ODI scores through the 5-year follow-up. Researchers noted 80.6% of D+ILS patients and 73.2% of D+PS patients experienced a greater than 15-point improvement in ODI scores, which did not show a statistically significant difference between the groups. In addition, there were three major device-related complications in the D+ILS cohort and five in the D+PS group.
“Reviewing the uncensored data for 15-point improvement in ODI, it highlighted an interesting finding showing a significant difference early and sustained late improvement favoring D+ILS. This finding is important because it shows that although a patient may hit a setback in their healing continuum, overall patients experienced less disability and greater success at activities of daily life after D+ILS procedure compared to fusion,” researchers wrote in the study. – by Robert Linnehan.
Disclosures: Musacchio reports consulting fees and honoraria from Paradigm Spine, Medtronic, Centinel Spine and RTI. Please see the full study for a list of all other authors’ relevant financial disclosures.