Surgeon recommendation for spinal fusion may not improve outcomes vs. decompression alone
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Key takeaways:
- Surgeon opinion for decompression with fusion vs. decompression alone may not impact clinical outcomes.
- Random allocation for surgery yielded similar outcomes for patients with degenerative spondylolisthesis.
Results showed treatment of degenerative spondylolisthesis in agreement with surgeon recommendations to perform decompression with fusion may not be associated with improved outcomes compared with standard treatment of decompression alone.
“The study challenges spine surgeons’ ability to tailor surgical treatment in patients with degenerative spondylolisthesis,” Ivar M. Austevoll, MD, PhD, of Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital in Bergen, Norway, told Healio. “Instead of excessively believing in our experience and skills for fusion surgery, we should rely on current evidence for the less extensive, less expensive and safer decompression alone — until evidence exists for superior fusion surgery results in patient subgroups.”
Austevoll and colleagues assessed the impact of surgeon opinion vs. random allocation for decompression with fusion or decompression alone in a cohort of 222 patients (mean age, 66.2 years) with degenerative spondylolisthesis and spinal stenosis who underwent surgery with 2-year follow-up.
Overall, surgeons preferred decompression alone for 112 patients and decompression with fusion for 110 patients. Among the 112 patients with surgeon recommendations for decompression alone, 53% (n = 59) were randomly assigned to the treatment. Among the 110 patients with surgeon recommendations for decompression with fusion, 52% (n = 57) were randomly assigned to the treatment.
Austevoll and colleagues found 75% of patients (n = 87) who received surgery in agreement with surgeon recommendations and 73% of patients (n = 77) who received surgery in disagreement with surgeon recommendations had reductions of at least 30% in Oswestry Disability Index at 2 years.
In addition, Austevoll and colleagues found 7% of patients who received surgery in agreement with surgeon recommendations and 7% of patients who received surgery in disagreement with surgeon recommendations reported worsening conditions at 2-year follow-up.
“[Despite] adding the results of this study to the body of evidence, I am unsure whether a significant practice shift will occur in all countries,” Austevoll said. “Own preferences, local traditions and economic incentives may still contribute to spine surgeons’ restraint from performing decompression without fusion.”
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