Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

Health-related quality of life following decompression compared to decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian multicentre study

Can J Surg 2014;57(4)E126-E133 | PDF

Y. Raja Rampersaud, MD*†; Charles Fisher, MD, MHSc‡; Albert Yee, MD, MSc§; Marcel F. Dvorak, MD‡; Joel Finkelstein, MD, MSc§; Eugene Wai, MD, MSc¶**; Edward Abraham, MD††; Stephen J. Lewis, MD, MSc*†; David Alexander, MD‡‡; William Oxner, MD‡‡

From the *Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ont., †Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital University Health Network, University of Toronto, Toronto, Ont., ‡Combined Neurosurgical and Orthopaedic Spine Program (CNOSP), Department of Orthopaedics, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, BC, §Sunnybrook Health Sciences Centre, Toronto, Ont., ¶Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont., **Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont., ††Atlantic Health Science Corporation, St. John, NB, and ‡‡Dalhousie University, QEII Health Sciences Centre, Halifax, NS

Abstract

Background: Decompression alone (D) is a well-accepted treatment for patients with lumbar spinal stenosis (LSS) causing neurogenic claudication; however, D is controversial in patients with LSS who have degenerative spondylolisthesis (DLS). Our goal was to compare the outcome of anatomy-preserving D with decompression and fusion (DF) for patients with grade I DLS. We compared patients with DLS who had elective primary 1–2 level spinal D at 1 centre with a cohort who had 1–2 level spinal DF at 5 other centres.

Methods: Patients followed for at least 2 years were included. Primary analysis included comparison of change in SF-36 physical component summary (PCS) scores and the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB).

Results: There was no significant difference in baseline SF-36 scores between the groups. The average change in PCS score was 10.4 versus 11.4 (p = 0.61) for the D and DF groups, respectively. Sixty-seven percent of the D group and 71% of the DF group attained MCID, while 64% of both D and DF groups attained SCB. There was no significant difference between D and DF for change in PCS score (p = 0.74) or likelihood of reaching MCID (p = 0.81) or SCB (p = 0.85) after adjusting for other variables.

Conclusion: In select patients with DLS, the outcome of D is comparable to DF at a minimum of 2 years.

Résumé

Contexte : La décompression seule est un traitement bien accepté pour la sténose lombaire (SL) causant une claudication neurogène. Son utilisation ne fait cependant pas l’unanimité chez les patients atteints de SL qui souffrent d’un spondylolisthésis dégénératif (SLD). Notre objectif était de comparer l’issue d’une décompression avec préservation anatomique à celle d’une décompression-arthrodèse (DA) chez des patients atteints de SLD de grade 1. Nous avons comparé les patients atteints de SLD ayant subi une décompression élective primaire de niveau 1–2 dans un centre à une cohorte ayant subi une DA de niveau 1–2 effectuée dans 5 autres centres.

Méthodes : Nous avons inclus les patients qui ont été suivis pendant au moins 2 ans. L’analyse primaire comportait une comparaison des changements aux scores sommaires pour la composante physique (CP) du questionnaire SF-36 et la proportion de patients ayant obtenu une différence minimale cliniquement importante (DMCI) et en ayant tiré un bienfait clinique substantiel (BCS).

Résultats : Il n’y avait pas de différence significative entre les scores SF-36 des 2 groupes au départ. Le changement moyen du score pour la CP a été de 10,4 c. 11,4 (p = 0,61) dans les groupes soumis à la décompression et à la DA, respectivement. Soixante-sept pour cent des patients du groupe soumis à la décompression et 71 % du groupe soumis à la DA ont obtenu une DMCI, tandis que 64 % des 2 groupes ont obtenu un BCS. On n’a noté aucune différence significative entre les groupes soumis à la décompression et à la DA pour ce qui est du changement du score pour la CP (p = 0,74) ou de la probabilité d’obtenir une DMCI (p = 0,81) ou un BCS (p = 0,85) après ajustement pour tenir compte d’autres variables.

Conclusion : Chez certains patients souffrant de SLD, l’issue de la décompression est comparable à celle de la DA après une période minimale de 2 ans.


Accepted for publication Jan. 27, 2014

Acknowledgements: This study was supported by a grant from the Canadian Spine Society through unrestricted research funds from Depuy, Medtronic, Stryker, and Synthes. Additional Funding was also received from the Minimal Access Ambulatory Surgical Spine Research and Education Fund, Toronto General and Western Hospital Foundation.

Competing interests: Y.R. Rampersaud is a paid consultant of Medtronic. C. Fisher is a paid consultant of Medtronic and Nuvasive and has received grants from Medtronic, AO Spine and the Orthopaedic Research and Education Foundation. M. Dvorak and E. Abraham are paid consultants of and have received speaker fees and travel assistance from Medtronic. W. Oxner has received honoraria and speaker fees from Medtronic. No other competing interests declared.

Contributors: All authors designed the study and acquired the data. Y.R. Rampersaud and C. Fisher analyzed the data. Y.R. Rampersaud wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/cjs.032213

Correspondence to: Y.R. Rampersaud, Division of Orthopaedic Surgery and
Neurosurgery, Toronto Western Hospital, 399 Bathurst St. East Wing, 1-441, Toronto ON M5T 2S8; raja.rampersaud@uhn.on.ca