Trends in Surgical Techniques to Treat Degenerative Lumbar Spondylolisthesis
Introduction: Degenerative lumbar spondylolisthesis (DLS) is common. DLS can affect the facet joints and cause spinal stenosis that may result in low back and leg pain.
Purpose: Review and report on treatment changes in patients with DLS. The authors sought to determine if the use of instrumentation had significantly changed, are there regional variations in treatment of patients with DLS, and if outcomes differ based on the type of procedure performed.
Methods: A retrospective review of the American Board of Orthopaedic Surgery’s (ABOS) electronic database of cases, outcomes and complications for a 13-year period (1999-2011) was made by board candidates.
The database search included all patients who received surgical treatment of DLS during the period 1999 to 2011 (n=5,639). Patients were grouped according to surgical treatment received: uninstrumented posterolateral fusion (PL), instrumented PL without interbody fusion (IF), instrumented PL with interbody device (IF), and decompression without fusion. Furthermore, consistent with the ABOS database, surgeons were grouped by geographic regions (Midwest, Northeast, Northwest, South, Southeast, and Southwest).
Results: Table 1 reflects a sampling of the results by year of the surgical procedures performed during the study to treat patients with DLS. Overall, probability value was P<0.001. Tables 2 provides a sampling of the surgical complications.
Conclusion: Additional outcome studies of patients with degenerative lumbar spondylolisthesis are needed to determine what is driving surgical decision-making.
- Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, Radcliff KE. National Trends in the Use of Fusion Techniques to Treat Degenerative Spondylolisthesis. Spine. 2014;39:1584-1589.
This is a very interesting retrospective paper. The authors queried the ABOS database of cases submitted by orthopaedic surgeons who were sitting for their board exams. There were 5,639 cases for the period 1999 to 2011.
The significant finding is that IF for degenerative lumbar spondylolisthesis increased significantly while the use of PL fusion as a stand-alone treatment decreased. This trend would seem to indicate that the training of new graduates evolved over the study time period to include IF as a surgical option for DLS, and treatment of DLS had also progressed.
Another interesting point is the complication rates for either intervention were not significantly different. What is unclear is—What is the driver for this change in treatment? Is it better training, newer instrumentation, and/or financial interest?