uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
Does fusion improve the outcome after decompressive surgery for lumbar spinal stenosis?: a two-year follow-up study involving 5390 patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
2013 (English)In: The Bone & Joint Journal, ISSN 2049-4408, Vol. 95-B, no 7, 960-965 p.Article in journal (Refereed) Published
Abstract [en]

Whether to combine spinal decompression with fusion in patients with symptomatic lumbar spinal stenosis remains controversial. We performed a cohort study to determine the effect of the addition of fusion in terms of patient satisfaction after decompressive spinal surgery in patients with and without a degenerative spondylolisthesis.                  

The National Swedish Register for Spine Surgery (Swespine) was used for the study. Data were obtained for all patients in the register who underwent surgery for stenosis on one or two adjacent lumbar levels. A total of 5390 patients fulfilled the inclusion criteria and completed a two-year follow-up. Using multivariable models the results of 4259 patients who underwent decompression alone were compared with those of 1131 who underwent decompression and fusion. The consequence of having an associated spondylolisthesis in the operated segments pre-operatively was also considered.                

At two years there was no significant difference in patient satisfaction between the two treatment groups for any of the outcome measures, regardless of the presence of a pre-operative spondylolisthesis. Moreover, the proportion of patients who required subsequent further lumbar surgery was also similar in the two groups.                  

In this large cohort the addition of fusion to decompression was not associated with an improved outcome.

Place, publisher, year, edition, pages
2013. Vol. 95-B, no 7, 960-965 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-210450DOI: 10.1302/0301-620X.95B7.30776PubMedID: 23814250OAI: oai:DiVA.org:uu-210450DiVA: diva2:662754
Available from: 2013-11-08 Created: 2013-11-08 Last updated: 2015-10-27Bibliographically approved
In thesis
1. On Surgery for Lumbar Spinal Stenosis
Open this publication in new window or tab >>On Surgery for Lumbar Spinal Stenosis
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of lumbar spinal stenosis (LSS) is steadily rising, mostly because of a noticeably older age structure. In Sweden, LSS surgery has increased continuously over the years and is presently the most common argument to undergo spine surgery. The purpose of the surgery is to decompress the neural elements in the stenotic spinal canal. To avoid instability, there has been a tradition to do the decompression with a complementary fusion, especially if degenerative spondylolisthesis is present preoperatively.

The overall aims of this thesis were to evaluate which method of surgery that generally can be considered to give sufficiently good clinical results with least cost to society and risk of complications and to determine whether there is a difference in outcome between smokers and non-smokers.

The Swespine Register was used to collect data on clinical outcome after LSS surgery. In two of the studies, large cohorts were observed prospectively with follow-up after 2 years. Data were analysed in a multivariate model and logistic regression. In a randomised controlled trial (RCT, the Swedish Spinal Stenosis Study), 233 patients were randomised to either decompression with fusion or decompression alone and then followed for 2 years. The consequence of preoperative degenerative spondylolisthesis on the results was analysed and a health economic evaluation performed. The three-dimensional CT technique was used in a radiologic biomechanical pilot study to evaluate the stabilising role of the segmental midline structures in LSS with preoperative degenerative spondylolisthesis by comparing laminectomy with bilateral laminotomies.

Smokers, in comparison with non-smokers, showed less improvement after surgery for LSS. Decompression with fusion did not lead to better results compared with decompression alone, no matter if degenerative spondylolisthesis was present preoperatively or not; nor was decompression with fusion found to be more cost-effective than decomression alone. The instability caused by a decompression proved to be minimal and removal of the midline structures by laminectomy did not result in increased instability compared with the preservation of these structures by bilateral laminotomies.

In LSS surgery, decompression without fusion should generally be the treatment of choice, regardless of whether preoperative degenerative spondylolisthesis is present or not. Special efforts should be targeted towards smoking cessation prior to surgery.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 66 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1135
spinal stenosis, decompression, fusion, degenerative spondylolisthesis
National Category
Research subject
Orthopaedics; Neurosurgery
urn:nbn:se:uu:diva-262525 (URN)978-91-554-9340-0 (ISBN)
Public defence
2015-11-06, Eva Netzeliussalen, Blåsenhus, von Kraemers Allé 1A, Uppsala, 13:00 (Swedish)
Available from: 2015-10-15 Created: 2015-09-16 Last updated: 2015-10-27

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Search in DiVA

By author/editor
Michaëlsson, KarlSandén, Bengt
By organisation
UCR-Uppsala Clinical Research CenterOrthopaedics
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 289 hits
ReferencesLink to record
Permanent link

Direct link