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

Direct link
Efficacy of fusion surgery for lumbar spinal stenosis- Clinical and economic results from a 2-year multicenter randomised controlled trial in sweden.
2015 (English)In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406Article in journal (Other academic) Submitted
Place, publisher, year, edition, pages
National Category
URN: urn:nbn:se:uu:diva-262518OAI: oai:DiVA.org:uu-262518DiVA: diva2:854150
Available from: 2015-09-16 Created: 2015-09-16 Last updated: 2015-10-27
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

In the same journal
New England Journal of Medicine

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

Total: 166 hits
ReferencesLink to record
Permanent link

Direct link