Our Summary

This study looked at the outcomes of two types of back surgery, specifically for a condition called lumbar degenerative spondylolisthesis. In this condition, one of the vertebrae in the lower back slides forward onto the bone directly beneath it. The two types of surgeries researched are called minimally invasive posterior lumbar interbody fusion (MI-PLIF) and conventional open posterior lumbar interbody fusion (O-PLIF).

The researchers wanted to see how often patients experienced complications in the segments of the spine adjacent to where the surgery took place, which is known as adjacent segment pathology (ASP). To do this, they looked at the records of 100 patients who had one of these surgeries and followed up with them for an average of over eight years.

What they found was that significantly fewer patients who had the minimally invasive surgery experienced ASP, compared to those who had the more conventional surgery. After five years, they predicted only about 1.5% of the minimally invasive group would experience ASP, compared to about 9.4% in the conventional group. After ten years, they predicted this would increase to 6.3% in the minimally invasive group and 28.2% in the conventional group.

In simpler terms, the study suggests that opting for the less invasive surgery could mean a lower chance of experiencing complications in areas of the spine close to where the operation was performed.

FAQs

  1. What is lumbar degenerative spondylolisthesis and what types of surgery are used to treat it?
  2. What is adjacent segment pathology (ASP) and how was it studied in relation to the two types of back surgery?
  3. According to the study, how does the rate of ASP complications compare between patients who underwent minimally invasive posterior lumbar interbody fusion and those who underwent conventional open posterior lumbar interbody fusion?

Doctor’s Tip

Therefore, a helpful tip a doctor might give a patient considering lumbar fusion surgery is to discuss the option of minimally invasive surgery with their surgeon. This may result in a lower risk of developing adjacent segment pathology in the future. It’s important to have an open and thorough discussion with your doctor about the potential benefits and risks of each type of surgery to make an informed decision about your treatment plan.

Suitable For

Patients who have lumbar degenerative spondylolisthesis and are recommended lumbar fusion surgery may benefit from considering minimally invasive posterior lumbar interbody fusion (MI-PLIF) as opposed to conventional open posterior lumbar interbody fusion (O-PLIF). This study suggests that patients who opt for the minimally invasive surgery may have a lower likelihood of experiencing adjacent segment pathology (ASP) in the years following the procedure. Therefore, patients who are concerned about potential complications in adjacent areas of the spine may want to discuss the option of MI-PLIF with their healthcare provider.

Timeline

Before lumbar fusion surgery, a patient may experience chronic lower back pain, sciatica, weakness or numbness in the legs, difficulty walking or standing, and limited mobility. They may have tried conservative treatments such as physical therapy, medications, and injections without success.

After lumbar fusion surgery, the patient will typically have a hospital stay of a few days followed by a period of recovery at home. They may experience pain and discomfort at the surgical site, along with restrictions on bending, lifting, and twisting. Physical therapy will be recommended to help regain strength and mobility. Gradually, the patient should experience improvements in their symptoms and be able to return to normal activities with reduced pain and improved function.

What to Ask Your Doctor

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

  1. What type of surgery do you recommend for my condition, and why?
  2. What are the potential risks and complications associated with lumbar fusion surgery?
  3. How long is the recovery process, and what can I expect in terms of pain and mobility post-surgery?
  4. What are the success rates for the type of surgery you are recommending?
  5. Will I need physical therapy or rehabilitation after the surgery, and if so, for how long?
  6. How long do the effects of lumbar fusion surgery typically last?
  7. Are there any lifestyle changes or restrictions I should be aware of after the surgery?
  8. What are the chances of developing adjacent segment pathology (ASP) after lumbar fusion surgery, and how can it be prevented?
  9. Are there any alternative treatments or therapies that I should consider before opting for surgery?
  10. Can you provide me with information on the long-term outcomes and follow-up care for patients who have undergone lumbar fusion surgery?

Reference

Authors: Mimura T, Tsutsumimoto T, Yui M, Takahashi J, Kuraishi S, Misawa H. Journal: Spine J. 2021 Aug;21(8):1297-1302. doi: 10.1016/j.spinee.2021.03.027. Epub 2021 Mar 27. PMID: 33785474