To fuse or not to fuse: a survey among members of the German Spine Society (DWG) regarding lumbar degenerative spondylolisthesis and spinal stenosis
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Surgical treatment methods for degenerative spondylolisthesis (decompression versus decompression and fusion) have been critically debated. The medical care situation is almost unknown for either treatment. Therefore, the aim of the present study was to provide information regarding the use of parameters for decision-making and the employment of surgical techniques.
Materials and methods
A web-based survey was performed among members of the German-Spine-Society (DWG). Information regarding participant characteristics (specialty, age, DWG certification status, number of spine surgeries performed at the participant’s institution each year, institutional status), estimates of the use of both treatment options, clinical and morphological decision-making criteria for additive fusion, and the surgical technique used was queried.
305 members (45% neurosurgeons/ 55% orthopedic or trauma surgeons) participated in the present study. The participants estimated that in 41.7% of the cases, decompression only was required, while 55.6% would benefit from additional fusion. Among the participants, 74% reported that low back pain was an important indicator of the need for fusion if the numerical rating scale for back pain was at least 6/10. The most commonly used decompression technique was minimally invasive unilateral laminotomy, whereas open approach-based interbody fusion with transpedicular fixation and laminotomy was the most frequently used fusion technique. Specialty, age, certification status, and institutional status had a partial effect on the responses regarding indications, treatment and surgical technique.
The present survey depicts the diversity of approaches to surgery for degenerative spondylolistheses in Germany. Considerable differences in treatment selection were observed in relation to the participants’ educational level and specialty.
KeywordsDegenerative spondylolisthesis Fusion Decompression Indication Surgical technique Survey
No funding was received for the present study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Brunner M, Schwarz T, Zeman F, König M, Grifka J, Benditz A (2018) Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients. Arch Orthop Trauma Surg 138:901–909CrossRefGoogle Scholar
- 2.Weinstein JN, Lurie JD, Tosteson TD, Zhao W, Blood EA, Tosteson AN, Birkmeyer N, Herkowitz H, Longley M, Lenke L, Emery S, Hu SS (2009) Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. Four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am 91:1295–1304CrossRefGoogle Scholar
- 3.Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA, Birkmeyer NJ, Hilibrand AS, Herkowitz H, Cammisa FP, Albert TJ, Emery SE, Lenke LG, Abdu WA, Longley M, Errico TJ, Hu SS (2007) Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med 356:2257–2270CrossRefGoogle Scholar
- 11.Inui T, Murakami M, Nagao N, Miyazaki K, Matsuda K, Tominaga Y, Kitano M, Hasegawa H, Tominaga S (2017) Lumbar degenerative spondylolisthesis: changes in surgical indications and comparison of instrumented fusion with two surgical decompression procedures. Spine (Phila Pa 1976) 42:E15–E24CrossRefGoogle Scholar
- 21.Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233CrossRefGoogle Scholar
- 28.Okuda S, Oda T, Miyauchi A, Tamura S, Hashimoto Y, Yamasaki S, Haku T, Kanematsu F, Ariga K, Ohwada T, Aono H, Hosono N, Fuji T, Iwasaki M (2008) Lamina horizontalization and facet tropism as the risk factors for adjacent segment degeneration after PLIF. Spine (Phila Pa 1976) 33:2754–2758CrossRefGoogle Scholar
- 29.Videbaek TS, Christensen FB, Soegaard R, Hansen ES, Hoy K, Helmig P, Niedermann B, Eiskjoer SP, Bunger CE (2006) Circumferential fusion improves outcome in comparison with instrumented posterolateral fusion: long-term results of a randomized clinical trial. Spine (Phila Pa 1976) 31:2875–2880CrossRefGoogle Scholar