No association between operation type and incidence of revision surgery for degenerative lumbar spinal stenosis patients

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Nils H. Ulrich

There is no significant association between the type of index operation—decompression alone or decompression with fusion—and incidence of revision surgery or the outcomes of pain, disability, and quality of life among patients after three years in those with degenerative lumbar spinal stenosis (DLSS). This is according to recent research, published in the JAMA Network Open by Nils H. Ulrich (University Spine Centre Zurich, Zurich, Switzerland) et al.

According to the researchers, only limited data derived from large prospective cohort studies exist on the incidence of revision surgery among patients who undergo operations for DLSS.

This research analysed data from a multicentre, prospective cohort study, the Lumbar Stenosis Outcome Study, which included patients aged 50 years or older with DLSS at eight spine surgery and rheumatology units in Switzerland between December 2010 and December 2015.

All patients underwent either decompression surgery alone or decompression with fusion surgery for DLSS and the follow-up period was three years.

The primary outcome was the cumulative incidence of revision operations. Secondary outcomes included changes in patient-reported outcome measures such as Spinal Stenosis Measure (SSM) symptom severity and physical function subscale scores and the EuroQol Health-Related Quality of Life 5-Dimension 3-Level questionnaire (EQ-5D-3L) summary index score.

A total of 328 patients (165 [50.3%] men; median age, 73 years [interquartile range, 66–78 years]) were included in the analysis. Of these, 256 (78%) underwent decompression alone and 72 (22%) underwent decompression with fusion.

The study found that the cumulative incidence of revisions after three years of follow-up was 11.3% (95% confidence interval [CI], 7.4%–15.1%) for the decompression alone group and 13.9% (95% CI, 5.5%–21.5%) for the fusion group (log-rank p=0.6).

There was no significant difference in the need for revision between the two groups over time (unadjusted absolute risk difference, 2.6% [95% CI, −6.3% to 11.4%]; adjusted absolute risk difference, 3.9% [95% CI, −5.2% to 17%]; adjusted hazard ratio, 1.4 [95% CI, 0.63–3.13]).

In addition, the number of revisions was significantly associated with higher SSM symptom severity scores (β, 0.171; 95% CI, 0.047–0.295; p=0.007) and lower EQ-5D-3L summary index scores (β, −0.061; 95% CI, −0.105 to −0.017; p=0.007) but not with higher SSM physical function scores (β, 0.068; 95% CI, −0.036 to 0.172; p=0.2). The type of index operation was not significantly associated with the corresponding outcomes.

Speaking to Spinal News International, Ulrich said: “Our lumbar spinal outcome study is an important addition to the mentioned randomised clinical trials published from the US and Norway in the New England Journal of Medicine in 2016 and 2021 respectively. In addition, it provides some guidance for all spine specialists to provide patients with an image during the in-office consultation regarding the incidence of re-operation after decompression or decompression plus fusion.”


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