Spinal fusion: Difference between revisions

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imported>Robert Badgett
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==Effectiveness==
==Effectiveness==
===Degenerative spondylolisthesis and spinal stenosis===
===Degenerative spondylolisthesis and spinal stenosis===
"In nonrandomized as-treated  comparisons with careful control for potentially confounding baseline  factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in  pain and function during a period of 2 years than patients treated  nonsurgically" according to a [[randomized controlled trial]]. <ref  name="pmid17538085">{{cite journal| author=Weinstein JN, Lurie JD,  Tosteson TD, Hanscom B, Tosteson AN, Blood EA et al.| title=Surgical  versus nonsurgical treatment for lumbar degenerative spondylolisthesis. |  journal=N Engl J Med | year= 2007 | volume= 356 | issue= 22 | pages=  2257-70 | pmid=17538085 | doi=10.1056/NEJMoa070302 | pmc=PMC2553804 |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17538085  }} </ref>
"In nonrandomized as-treated  comparisons with careful control for potentially confounding baseline  factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in  pain and function during a period of 2 years than patients treated  nonsurgically" according to a [[randomized controlled trial]]. <ref  name="pmid17538085">{{cite journal| author=Weinstein JN, Lurie JD,  Tosteson TD, Hanscom B, Tosteson AN, Blood EA et al.| title=Surgical  versus nonsurgical treatment for lumbar degenerative spondylolisthesis. |  journal=N Engl J Med | year= 2007 | volume= 356 | issue= 22 | pages=  2257-70 | pmid=17538085 | doi=10.1056/NEJMoa070302 | pmc=PMC2553804 |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17538085  }} </ref>


===chronic nonspecific lumbalgia===
===Chronic nonspecific lumbalgia===
Several [[systematic review]]s of spinal fusion for chronic nonspecific [[lumbalgia]] have been performed."Surgery for radiculopathy with  herniated lumbar disc and symptomatic spinal stenosis is associated with  short-term benefits compared to nonsurgical therapy, though benefits  diminish with long-term follow-up in some trials" according to one [[systematic review]]. <ref  name="pmid19363455">{{cite journal| author=Chou R, Baisden J,  Carragee EJ, Resnick DK, Shaffer WO, Loeser JD| title=Surgery for low  back pain: a review of the evidence for an American Pain Society  Clinical Practice Guideline. | journal=Spine (Phila Pa 1976) | year=  2009 | volume= 34 | issue= 10 | pages= 1094-109 | pmid=19363455 |  doi=10.1097/BRS.0b013e3181a105fc | pmc= | url= }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19841448  Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-11]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949183  Review in: Evid Based Med. 2009 Dec;14(6):180-1] </ref>"Surgery may be more efficacious  than unstructured nonsurgical care for chronic back pain but may not be  more efficacious than structured cognitive-behavior therapy" according to one [[systematic review]].<ref  name="pmid17414918">{{cite journal| author=Mirza SK, Deyo RA|  title=Systematic review of randomized trials comparing lumbar fusion  surgery to nonoperative care for treatment of chronic back pain. |  journal=Spine (Phila Pa 1976) | year= 2007 | volume= 32 | issue= 7 |  pages= 816-23 | pmid=17414918 | doi=10.1097/01.brs.0000259225.37454.38 |  pmc= |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17414918  }} </ref>
Several [[systematic review]]s of spinal fusion for chronic nonspecific [[lumbalgia]] have been performed."Surgery for radiculopathy with  herniated lumbar disc and symptomatic spinal stenosis is associated with  short-term benefits compared to nonsurgical therapy, though benefits  diminish with long-term follow-up in some trials" according to one [[systematic review]]. <ref  name="pmid19363455">{{cite journal| author=Chou R, Baisden J,  Carragee EJ, Resnick DK, Shaffer WO, Loeser JD| title=Surgery for low  back pain: a review of the evidence for an American Pain Society  Clinical Practice Guideline. | journal=Spine (Phila Pa 1976) | year=  2009 | volume= 34 | issue= 10 | pages= 1094-109 | pmid=19363455 |  doi=10.1097/BRS.0b013e3181a105fc | pmc= | url= }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19841448  Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-11]  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19949183  Review in: Evid Based Med. 2009 Dec;14(6):180-1] </ref>"Surgery may be more efficacious  than unstructured nonsurgical care for chronic back pain but may not be  more efficacious than structured cognitive-behavior therapy" according to one [[systematic review]].<ref  name="pmid17414918">{{cite journal| author=Mirza SK, Deyo RA|  title=Systematic review of randomized trials comparing lumbar fusion  surgery to nonoperative care for treatment of chronic back pain. |  journal=Spine (Phila Pa 1976) | year= 2007 | volume= 32 | issue= 7 |  pages= 816-23 | pmid=17414918 | doi=10.1097/01.brs.0000259225.37454.38 |  pmc= |  url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17414918  }} </ref>


Revision as of 20:20, 5 April 2012

In medicine, spinal fusion is "operative immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies with a short bone graft or often with diskectomy or laminectomy."[1]

Effectiveness

Degenerative spondylolisthesis and spinal stenosis

"In nonrandomized as-treated comparisons with careful control for potentially confounding baseline factors, patients with degenerative spondylolisthesis and spinal stenosis treated surgically showed substantially greater improvement in pain and function during a period of 2 years than patients treated nonsurgically" according to a randomized controlled trial. [2]

Chronic nonspecific lumbalgia

Several systematic reviews of spinal fusion for chronic nonspecific lumbalgia have been performed."Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials" according to one systematic review. [3]"Surgery may be more efficacious than unstructured nonsurgical care for chronic back pain but may not be more efficacious than structured cognitive-behavior therapy" according to one systematic review.[4]

Several randomized controlled trials of spinal fusion for chronic nonspecific lumbalgia have been performed."Lumbar fusion in a well-informed and selected group of patients with severe CLBP can diminish pain and decrease disability more efficiently than commonly used nonsurgical treatment." according to a randomized controlled trial. [5]" The success rate was 50% in the fusion group and 48% in the cognitive intervention/exercise group" according to a randomized controlled trial. [6]"The main outcome measure showed equal improvement in patients with chronic low back pain and disc degeneration randomized to cognitive intervention and exercises, or lumbar fusion." according to a randomized controlled trial. [7]"Both groups reported reductions in disability during two years of follow-up, possibly unrelated to the interventions" according to a randomized controlled trial. [8]

References

  1. ↑ Anonymous (2024), Spinal fusion (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Weinstein JN, Lurie JD, Tosteson TD, Hanscom B, Tosteson AN, Blood EA et al. (2007). "Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.". N Engl J Med 356 (22): 2257-70. DOI:10.1056/NEJMoa070302. PMID 17538085. PMC PMC2553804. Research Blogging.
  3. ↑ Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD (2009). "Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline.". Spine (Phila Pa 1976) 34 (10): 1094-109. DOI:10.1097/BRS.0b013e3181a105fc. PMID 19363455. Research Blogging. Review in: Ann Intern Med. 2009 Oct 20;151(8):JC4-11 Review in: Evid Based Med. 2009 Dec;14(6):180-1
  4. ↑ Mirza SK, Deyo RA (2007). "Systematic review of randomized trials comparing lumbar fusion surgery to nonoperative care for treatment of chronic back pain.". Spine (Phila Pa 1976) 32 (7): 816-23. DOI:10.1097/01.brs.0000259225.37454.38. PMID 17414918. Research Blogging.
  5. ↑ Fritzell P, Hägg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study Group (2001). "2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group.". Spine (Phila Pa 1976) 26 (23): 2521-32; discussion 2532-4. PMID 11725230. [e]
  6. ↑ Brox JI, Reikerås O, Nygaard Ø, Sørensen R, Indahl A, Holm I et al. (2006). "Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study.". Pain 122 (1-2): 145-55. DOI:10.1016/j.pain.2006.01.027. PMID 16545523. Research Blogging.
  7. ↑ Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A et al. (2003). "Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration.". Spine (Phila Pa 1976) 28 (17): 1913-21. DOI:10.1097/01.BRS.0000083234.62751.7A. PMID 12973134. Research Blogging.
  8. ↑ Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R et al. (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 (7502): 1233. DOI:10.1136/bmj.38441.620417.8F. PMID 15911537. PMC PMC558090. Research Blogging. Review in: J Fam Pract. 2005 Sep;54(9):752
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