Posterior facet replacement may yield decompression, stabilization for spondylolisthesis
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Key takeaways:
- Posterior facet replacement had a higher rate of clinical success for the overall composite measure vs. fusion.
- The minimum 15-point improvement in Oswestry Disability Index favored posterior facet replacement.
Results showed use of a posterior facet replacement device may provide adequate decompression and dynamic stabilization in patients with lumbar stenosis with degenerative spondylolisthesis.
Although lumbar stenosis with degenerative spondylolisthesis has historically been treated with decompression and fusion, Dom Coric, MD, said fusion stops motion at the facets, which may lead to increased stress at the levels above and below the fusion and can lead to increased risk of reoperation. However, he noted stabilization may be achieved and motion may be maintained with the use of decompression and an artificial facet.
“[With an artificial facet], now you have a situation where the nerves are free; the patients have done well; and you have maintained the motion, which is more of a natural phenomenon. And furthermore, you’re not placing this additional stress at the adjacent levels,” Coric, of Carolina Neurosurgery and Spine Associates and SpineFirst Atrium Health, told Healio. “So it’s a win-win situation, and that’s what the results of the study bore out: The patients that had decompression and dynamic stabilization with facet replacement did better than patients who had decompression and stabilization with the fusion.”
Posterior facet replacement vs. fusion
Coric and colleagues randomly assigned 249 patients with one-level symptomatic lumbar stenosis with grade I degenerative spondylolisthesis to undergo either posterior facet replacement with the Total Posterior Spine system (n=170; TOPS, Premia Spine) or transforaminal lumbar interbody fusion (n=79; TLIF). Researchers collected the Oswestry Disability Index (ODI) and VAS for back and leg pain preoperatively and at 6 weeks and at 3, 6, 12 and 24 months postoperatively. Researchers considered no reoperations, no device breakage, reduction of ODI of 15 points or more and no new or worsening neurological deficit as the primary outcome, with patients considered clinically successful if they met all four measures.
Results showed 85% of patients in the TOPS group met the overall composite measure for clinical success compared with 64% of patients in the TLIF group. Researchers found a statistically significant difference in the percentage of patients reporting a minimum 15-point improvement in ODI, with 93% in the TOPS group vs. 81% in the TLIF group. However, researchers noted no statistically significant difference in the percentage of patients reporting a minimum 20-point improvement in VAS back pain and leg pain scores between the two groups.
Rate of reintervention
The TOPS group had a lower rate of surgical reintervention for facet replacement vs. the TLIF group (5.9% vs. 8.8%), according to results. From preoperatively to 24 months, researchers found patients in the TOPS group demonstrated maintenance of flexion/extension range of motion.
“One-level TLIF is a common and well thought of operation. In other words, you would expect the success rate of that type of operation to be reasonably high. So, to show superiority to that, I think, is a positive,” Coric said.
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