Our Summary

This research paper is a systematic review of several studies that compare two different surgical treatments for a condition called degenerative lumbar spondylolisthesis, which is a type of lower back instability.

The two treatments are called instrumented and noninstrumented posterolateral spine fusions. The ‘instrumented’ treatment involves using medical devices to help fuse the bones in the spine, while the ’noninstrumented’ treatment does not use these devices.

The researchers found seven relevant studies to include in their review, which involved a total of 672 patients. They found that the instrumented treatment resulted in higher rates of successful fusion of the spinal bones and lower rates of a complication called pseudarthrosis, where the bones don’t fuse properly.

However, when it came to how much the patients’ function improved, their pain levels, whether they needed further surgery, or other complications, there was no difference between the two treatments. So while the instrumented treatment may lead to more successful fusions, it doesn’t necessarily lead to better outcomes for the patients in other respects.

FAQs

  1. What is the difference between instrumented and noninstrumented posterolateral spine fusions?
  2. Did the research find any difference in the level of pain relief or functional improvement between the two treatments?
  3. What advantages does the instrumented treatment have over the noninstrumented treatment according to the research?

Doctor’s Tip

Overall, a doctor might advise a patient considering lumbar fusion to discuss the potential benefits and risks of both instrumented and noninstrumented procedures with their surgeon. It’s important to weigh the higher fusion success rate of the instrumented procedure against the fact that it may not necessarily lead to better overall outcomes. Each patient’s individual circumstances and preferences should be taken into account when making a decision about which type of lumbar fusion to undergo. Additionally, it’s important for patients to follow their doctor’s post-operative care instructions carefully to maximize their chances of a successful recovery.

Suitable For

Patients who are typically recommended lumbar fusion are those with degenerative lumbar spondylolisthesis, which is characterized by instability in the lower back. These patients may experience symptoms such as back pain, leg pain, numbness, and weakness. Lumbar fusion may be recommended for patients who have not responded to conservative treatments such as physical therapy, medications, and injections.

In particular, patients with severe symptoms, progressive neurological deficits, or spinal instability may be candidates for lumbar fusion. Additionally, patients who have failed previous surgeries or have significant disc degeneration may also be recommended for lumbar fusion.

Overall, the decision to recommend lumbar fusion is based on a thorough evaluation of the patient’s symptoms, medical history, physical examination findings, and imaging studies. The goal of lumbar fusion is to stabilize the spine, alleviate symptoms, and improve the patient’s quality of life.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic lower back pain, leg pain, or numbness due to degenerative lumbar spondylolisthesis.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the extent of the condition.
  3. Patient undergoes conservative treatments such as physical therapy, medications, or injections to manage symptoms.
  4. If conservative treatments are unsuccessful, patient may be recommended for lumbar fusion surgery.

After lumbar fusion:

  1. Patient undergoes pre-operative assessments and preparations for surgery.
  2. Patient undergoes lumbar fusion surgery, which may involve instrumented or noninstrumented techniques.
  3. Patient is monitored post-operatively for complications and to ensure proper healing of the fused spinal bones.
  4. Patient undergoes physical therapy and rehabilitation to regain strength and function in the lower back.
  5. Patient follows up with their healthcare provider for long-term monitoring and management of any residual symptoms or complications.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion include:

  1. What are the risks and benefits of both instrumented and noninstrumented posterolateral spine fusions for my condition?
  2. How likely is it that each type of fusion will successfully fuse the bones in my spine?
  3. What are the potential complications or side effects associated with each type of fusion?
  4. How will each type of fusion impact my pain levels and function after surgery?
  5. Will I need additional surgeries or treatments in the future if I choose one type of fusion over the other?
  6. Are there any specific factors about my condition or medical history that make one type of fusion more suitable for me than the other?
  7. What is the recovery process like for each type of fusion, and how long can I expect to be out of work or limited in my activities?
  8. Are there any alternative treatments or therapies I should consider before deciding on lumbar fusion surgery?
  9. How experienced are you in performing both instrumented and noninstrumented posterolateral spine fusions, and what is your success rate with each type of surgery?
  10. Can you provide me with any additional resources or information to help me make an informed decision about lumbar fusion surgery?

Reference

Authors: Hirase T, Ling JF, Haghshenas V, Weiner BK. Journal: Clin Spine Surg. 2022 Jun 1;35(5):213-221. doi: 10.1097/BSD.0000000000001266. Epub 2021 Oct 22. PMID: 35239288