Abstract | STUDY DESIGN: Systematic review with meta-analysis. OBJECTIVE: To (1) evaluate long-term patient-centered clinical outcomes after lumbar arthrodesis with or without decompression for lumbar spondylosis (LS); and (2) compare these outcomes with those of alternative treatments, including nonsurgical and surgical which maintain mobility of the lumbar spine. SUMMARY OF BACKGROUND DATA: The effective treatment of LS is a complex clinical and economic concern for patients and health care providers. METHODS: SELECTION CRITERIA: (1) randomized controlled clinical trials (RCTs) comparing treatment effects of lumbar arthrodesis with other interventions; (2) participants: skeletally mature adults with lumbar degenerative disk disease. SEARCH METHODS: Ovid MEDLINE, Embase, the Cochrane Library, and others. All years through February of 2013 were included. Patient-centered clinical outcomes before treatment, at 12, 24, or >24 months of follow-up, and rate of complications and additional surgical treatment were collected. A meta-analysis was performed to evaluate pooled treatment effects. The GRADE approach was applied to evaluate the level of evidence. RESULTS: The review included 38 studies of 5738 participants. All studies showed strong or at least moderate treatment effects of lumbar arthrodesis at 12, 24, and 48-72 months of follow-up. The level of evidence was moderate at 12 and 24 months, and low at 48-72 months. The pooled long-term treatment effect of lumbar arthrodesis exceeded those of: nonsurgical treatment (P<0.0001) with a moderate level of evidence, and decompression without fusion (P=0.005) with a low level of evidence. The treatment effect of lumbar arthrodesis showed a small inferiority versus arthroplasty at 12 and 24 months of follow-up (P<0.001), but not after 24 months postoperative. CONCLUSIONS: This review indicates that surgical stabilization of the lumbar spine is an effective treatment for LS; in particular, for patients with severe chronic low back pain that has been resistant to ≥3 months of conservative therapy.
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Authors | Andriy Noshchenko, Lilian Hoffecker, Emily M Lindley, Evalina L Burger, Christopher M J Cain, Vikas V Patel |
Journal | Journal of spinal disorders & techniques
(J Spinal Disord Tech)
Vol. 28
Issue 9
Pg. E493-521
(Nov 2015)
ISSN: 1539-2465 [Electronic] United States |
PMID | 24901878
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Topics |
- Arthrodesis
(methods)
- Humans
- Intervertebral Disc Degeneration
(surgery)
- Low Back Pain
(etiology)
- Patient Outcome Assessment
- Publication Bias
- Surveys and Questionnaires
- Time Factors
- Treatment Outcome
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