Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials

Choon Sung Lee, Chang Ju Hwang, Dong-Ho Lee, Yung-Tae Kim, Hee Sang Lee, Choon Sung Lee, Chang Ju Hwang, Dong-Ho Lee, Yung-Tae Kim, Hee Sang Lee

Abstract

Background: Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques.

Methods: Relevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed.

Results: A literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion.

Conclusions: One low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

Keywords: Spinal fusion; Surgical approach; Systematic review.

Conflict of interest statement

The authors have no potential conflicts of interest relevant to this article.

References

    1. DiPaola CP, Molinari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg. 2008;16(3):130–139.
    1. Penta M, Fraser RD. Anterior lumbar interbody fusion: a minimum 10-year follow-up. Spine (Phila Pa 1976) 1997;22(20):2429–2434.
    1. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26(5):567–571.
    1. Christensen FB, Hansen ES, Eiskjaer SP, et al. Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine (Phila Pa 1976) 2002;27(23):2674–2683.
    1. Fritzell P, Hagg O, Wessberg P, Nordwall A Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 2002;27(11):1131–1141.
    1. Hallett A, Huntley JS, Gibson JN. Foraminal stenosis and single-level degenerative disc disease: a randomized controlled trial comparing decompression with decompression and instrumented fusion. Spine (Phila Pa 1976) 2007;32(13):1375–1380.
    1. Kim KT, Lee SH, Lee YH, Bae SC, Suk KS. Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine (Phila Pa 1976) 2006;31(12):1351–1357.
    1. Schofferman J, Slosar P, Reynolds J, Goldthwaite N, Koestler M. A prospective randomized comparison of 270 degrees fusions to 360 degrees fusions (circumferential fusions) Spine (Phila Pa 1976) 2001;26(10):E207–E212.
    1. Robinson KA, Dickersin K. Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol. 2002;31(1):150–153.
    1. van Tulder M, Furlan A, Bombardier C, Bouter L Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the cochrane collaboration back review group. Spine (Phila Pa 1976) 2003;28(12):1290–1299.
    1. Inamdar DN, Alagappan M, Shyam L, Devadoss S, Devadoss A. Posterior lumbar interbody fusion versus intertransverse fusion in the treatment of lumbar spondylolisthesis. J Orthop Surg (Hong Kong) 2006;14(1):21–26.
    1. Jacobs WC, Vreeling A, De Kleuver M. Fusion for low-grade adult isthmic spondylolisthesis: a systematic review of the literature. Eur Spine J. 2006;15(4):391–402.
    1. Moher D, Schulz KF, Altman D CONSORT Group (Consolidated Standards of Reporting Trials) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA. 2001;285(15):1987–1991.
    1. Zlowodzki M, Poolman RW, Kerkhoffs GM, Tornetta P, 3rd, Bhandari M International Evidence-Based Orthopedic Surgery Working Group. How to interpret a meta-analysis and judge its value as a guide for clinical practice. Acta Orthop. 2007;78(5):598–609.
    1. Hollis S, Campbell F. What is meant by intention to treat analysis? Survey of published randomised controlled trials. BMJ. 1999;319(7211):670–674.
    1. Juni P, Holenstein F, Sterne J, Bartlett C, Egger M. Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol. 2002;31(1):115–123.
    1. Moher D, Pham B, Klassen TP, et al. What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol. 2000;53(9):964–972.
    1. Egger M, Smith GD. Principles of and procedures for systematic reviews. In: Egger M, Smith GD, Altman DG, editors. Systematic reviews in health care: meta-analysis in context. London: BMJ Books; 2001. pp. 23–42.
    1. Greenhalgh T. How to read a paper: the basics of evidence based medicine. 1st ed. London: BMJ Books; 1999.
    1. van Limbeek J, Jacobs WC, Anderson PG, Pavlov PW. A systematic literature review to identify the best method for a single level anterior cervical interbody fusion. Eur Spine J. 2000;9(2):129–136.
    1. France JC, Yaszemski MJ, Lauerman WC, et al. A randomized prospective study of posterolateral lumbar fusion. Outcomes with and without pedicle screw instrumentation. Spine (Phila Pa 1976) 1999;24(6):553–560.
    1. Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976) 1999;24(17):1820–1832.
    1. Voor MJ, Mehta S, Wang M, Zhang YM, Mahan J, Johnson JR. Biomechanical evaluation of posterior and anterior lumbar interbody fusion techniques. J Spinal Disord. 1998;11(4):328–334.
    1. Madan S, Boeree NR. Outcome of posterior lumbar interbody fusion versus posterolateral fusion for spondylolytic spondylolisthesis. Spine (Phila Pa 1976) 2002;27(14):1536–1542.
    1. Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE. 1997 Volvo Award winner in clinical studies. The effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine (Phila Pa 1976) 1997;22(24):2813–2822.
    1. Blumenthal SL, Gill K. Can lumbar spine radiographs accurately determine fusion in postoperative patients? Correlation of routine radiographs with a second surgical look at lumbar fusions. Spine (Phila Pa 1976) 1993;18(9):1186–1189.
    1. Brodsky AE, Kovalsky ES, Khalil MA. Correlation of radiologic assessment of lumbar spine fusions with surgical exploration. Spine (Phila Pa 1976) 1991;16(6 Suppl):S261–S265.
    1. Kant AP, Daum WJ, Dean SM, Uchida T. Evaluation of lumbar spine fusion. Plain radiographs versus direct surgical exploration and observation. Spine (Phila Pa 1976) 1995;20(21):2313–2317.
    1. Larsen JM, Rimoldi RL, Capen DA, Nelson RW, Nagelberg S, Thomas JC., Jr Assessment of pseudarthrosis in pedicle screw fusion: a prospective study comparing plain radiographs, flexion/extension radiographs, CT scanning, and bone scintigraphy with operative findings. J Spinal Disord. 1996;9(2):117–120.
    1. Carreon LY, Djurasovic M, Glassman SD, Sailer P. Diagnostic accuracy and reliability of fine-cut CT scans with reconstructions to determine the status of an instrumented posterolateral fusion with surgical exploration as reference standard. Spine (Phila Pa 1976) 2007;32(8):892–895.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel