Our Summary

This study looked at how effective different types of surgery are for treating a condition called lumbar spinal stenosis, where the spinal canal in your lower back narrows. The researchers looked at a lot of different studies to see how patients fared after different types of surgery.

They found that combining two types of surgery - decompression and fusion - resulted in longer hospital stays, longer operations, and more blood loss than just doing decompression alone. However, doing decompression alone was better than fusion alone in terms of operation time, blood loss, and pain levels.

When they compared traditional surgery to a method called endoscopic discectomy, they found that the endoscopic method led to shorter hospital stays, less operation time, less blood loss, less pain, and better scores on a measure of physical function.

They also compared a method called transforaminal lumbar interbody fusion (TLIF) to a minimally invasive version (MIS-TLIF). The minimally invasive version resulted in shorter hospital stays but longer operation times, and better scores on a measure of physical health.

Finally, they found that doing decompression with a method called interlaminar stabilization resulted in shorter operation times and better scores on a measure of symptom severity, but worse scores on a measure of pain.

Despite these findings, the researchers emphasize that more high-quality studies with larger sample sizes and longer follow-up times are needed to figure out the best way to treat lumbar spinal stenosis.

FAQs

  1. What is lumbar spinal stenosis and how is it treated with surgery?
  2. What are the differences in outcomes between decompression and fusion surgeries, and which is more effective for treating lumbar spinal stenosis?
  3. How do traditional surgery, endoscopic discectomy, TLIF, and MIS-TLIF compare in terms of effectiveness, operation time, and recovery for patients with lumbar spinal stenosis?

Doctor’s Tip

A helpful tip a doctor might give a patient considering spinal fusion is to ask about the different surgical options available and discuss the potential benefits and risks of each procedure. It’s important to have a thorough understanding of the different methods and their potential outcomes in order to make an informed decision about your treatment. Additionally, it’s important to follow your doctor’s recommendations for post-operative care and rehabilitation to ensure the best possible outcome.

Suitable For

Patients with lumbar spinal stenosis who have not responded to conservative treatments such as physical therapy, medications, and injections are typically recommended for spinal fusion surgery. Patients with severe symptoms such as leg pain, weakness, and numbness that are affecting their quality of life and ability to perform daily activities may benefit from spinal fusion surgery. Additionally, patients with spinal instability, deformity, or significant disc degeneration may also be recommended for spinal fusion surgery. It is important for patients to discuss their symptoms and treatment options with a healthcare provider to determine the most appropriate course of action.

Timeline

Before spinal fusion:

  1. Patient experiences symptoms such as back pain, leg pain, numbness, and weakness.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, and CT scans to determine the cause of their symptoms.
  3. Patient may undergo conservative treatments such as physical therapy, medications, and injections to manage their symptoms.
  4. If conservative treatments are ineffective, patient may be recommended for spinal fusion surgery.

After spinal fusion:

  1. Patient undergoes pre-operative evaluations and preparations for surgery.
  2. Patient undergoes spinal fusion surgery, which involves joining two or more vertebrae together using bone grafts or metal implants.
  3. Patient may experience post-operative pain and discomfort, and will be monitored in the hospital for a few days.
  4. Patient undergoes physical therapy and rehabilitation to regain strength and mobility.
  5. Patient gradually resumes normal activities and follows up with their healthcare provider for long-term monitoring.

What to Ask Your Doctor

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

  1. What specific type of surgery do you recommend for my condition (e.g. decompression alone, fusion alone, combination of decompression and fusion)?
  2. What are the potential risks and complications associated with the recommended surgery?
  3. How long is the recovery process expected to be, and what can I expect in terms of pain management during this time?
  4. Are there any alternative treatments or less invasive procedures that could be considered before opting for spinal fusion?
  5. What is the success rate of the recommended surgery for treating my specific condition?
  6. Will I need physical therapy or rehabilitation after the surgery, and if so, for how long?
  7. How long will I need to stay in the hospital after the surgery, and what is the expected timeline for returning to normal activities?
  8. Are there any long-term implications or potential complications that I should be aware of after undergoing spinal fusion?
  9. How frequently will follow-up appointments be needed after the surgery, and what signs or symptoms should I watch for that may indicate a problem?
  10. Are there any lifestyle changes or precautions that I should take to ensure the best possible outcome following spinal fusion surgery?

Reference

Authors: Yang LH, Liu W, Li J, Zhu WY, An LK, Yuan S, Ke H, Zang L. Journal: Medicine (Baltimore). 2020 Jul 2;99(27):e20323. doi: 10.1097/MD.0000000000020323. PMID: 32629626