Expert consensus lacking on treatment of degenerative spondylolisthesis

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There is little consensus on the treatment of degenerative spondylolisthesis (DS) among members of both the Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery, according to new research, which also highlighted a substantial variation in treatment patterns, despite the majority of members utilising fusion. These findings are the result of a study, published in The Spine Journal by Kyle Morse (Hospital for Special Surgery, New York, USA) et al, which sought to describe current DS treatment practices and identify both the radiographic and clinical factors leading to the decision to fuse segments for single-level DS.

The study found that the most common radiographic parameters impacting treatment are instability, spondylolisthesis grade, and laterolisthesis, while mechanical low back pain, activity level, and neurogenic claudication are the most common clinical parameters.

For the study, surveys were administered to members of the two societies. Surgeon demographics and treatment practices were reported, and radiographic and clinical parameters were ranked by each surgeon with regards to their importance.

The primary analysis was limited to completed surveys. Baseline characteristics were summarised and clinical and radiographic parameters were ranked and compared. Ranking of each of the clinical and radiographic parameters was reported using best and worst rank, mean rank position, and percentiles. The most important, top three most important, and top five most important parameters were ordered given each parameter’s ranking frequency.

In total, 381 completed surveys were returned. With regards to fusion versus decompression, 19.9% of respondents chose to fuse all cases, 39.1% chose to fuse >75% of cases, 17.8% chose to fuse between 50% and 75% of cases, and 23.2% chose to fuse fewer than 25% of cases.

The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). In addition, 82.2% of respondents instrument all fusion cases.

Instability (93.2%), spondylolisthesis grade (59.8%), and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. With regards to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%), and neurogenic claudication (42.8%) were the top three clinical parameters.


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