Surgical Management Of Degenerative Spondylolisthesis Research Articles

Comparison of Surgical Outcomes between Cortical Bone Trajectory and Conventional Pedicle Screw Trajectory for Lumbar Degenerative Spondylolisthesis (systematic review of literature)

Abstract Background Pedicle screw fixation the gold standard for lumbar spine stabilization. Pedicle screw has fixation offers multiple advantages, allowing superior correction of spinal deformities, and reduced rates of loss of non-union. Cortical Bone Trajectory (CBT) is a new technique in which screws follow a caudal-to-cephalad path in the sagittal plane and a medial-to-lateral directed path in the transverse plane. CBT is reducing operative and post-operative complications and has high fixation strength. Purpose To Compare the clinical outcomes between CBT and traditional trajectory (TT) in surgical management of degenerative spondylolisthesis. Materials and Methods A comprehensive electronic search in Pubmed, MEDLINE and Chocrane library databases, Google scholar and Research gate for articles that published between 2009 to 2020 using these keywords: Cortical bone trajectory, Cortical bone trajectory-pedicle screw, Pedicle screw. Results The majority of literature suggests that the CBT technique results in similar or decreased postoperative back and leg pain compared to TT. Regarding the disability ODI and the operative time showed no significant differences between the CBT and TT. Radiographic outcomes between both studies show no statistical difference in fusion rates and vertebral slippage. Intraoperative blood loss was significantly less with CBT compared to TT. Conclusion there is no widely accepted consensus regarding comparison of clinical outcomes and complications between the CBT and TT procedures. Generally, indications for CBT and TT are similar between most studies, especially for common pathologies resulting in spondylolisthesis.

Transforaminal lumbar interbody fusion in degenerative spondylolisthesis

Introduction Spinal fusion surgery is a common technique used to treat degenerative lumbar pathologies including disc herniation with instability, spinal stenosis, and degenerative spondylolisthesis (DS). Minimally invasive transforaminal lumbar interbody fusion (TLIF) is a common surgical procedure for treatment of DS. Aim We aimed to assess the outcomes of TLIF in DS. Patients and methods This study was conducted on 15 patients treated for DS treated with TLIF. A written informed consent was taken from all participants after proper explanation of the study. The study assessed perioperative results related to the operative procedure such as blood loss, operation time, hospital stay, and complications. Oswestry Disability Index (ODI) questionnaire was filled for functional evaluation, and the visual analog scale was used to assess pain preoperatively and postoperatively. Result A total of 15 cases were included. The mean age of the included cases was 53.67 years, the mean BMI was 26.73, 53.3% of cases were female, and 33.3% of patients were smokers. There was a significant decrease in visual analog scale ODI after operation. Regarding complications, 73.3% had no early complications but 13.3% had wound infection and 6.7% had positioning neuropathy and postoperative hematoma. Late complications were founded in 33.3% in the form of adjacent segment disease in 13.3%, arthrodesis in 13.3%, and fusion failure in 6.7%. Conclusion This study shows that TLIF is an effective procedure in surgical management of DS. The TLIF gives better results regarding reduction of low back pain and leg pain, as well as reduction in ODI score in early follow-ups and similar results in late follow-ups.

Comparison of Surgical Outcomes between Cortical Bony Trajectory Screw and Traditional Trajectory Screw in Posterior Lumbar Interbody Fusion: A Systematic Review

Background: Pedicle screw is the main method for lumbar spine fixation. Pedicle screw fixation allowing correction of spinal Background Data: Pedicle screw is the main method for lumbar spine fixation. Pedicle screw fixation allows correction of spinal deformities and avoids nonunion. Cortical bony trajectory screw (CBTS) is a new procedure in which screw follows an inferior to superior pathway in the sagittal plane and a medial to lateral pathway in the transverse plane. CBTS reduces the operative and postoperative complications and has high fixation strength. Purpose: To compare the clinical and radiological outcomes between CBTS and traditional trajectory screw (TTS) in posterior lumbar interbody fusion. Study Design: Systematic review of literature. Materials and Methods: Comprehensive electronic search in PubMed, Cochrane Library databases, Google Scholar, and ResearchGate for articles that were published between 2009 and 2019 using the following keywords: cortical bony trajectory screw, cortical bony trajectory-pedicle screw, pedicle screw, and posterior lumbar interbody fusion. Results: Eleven articles met our inclusion criteria and were reported. The majority of the published data prove that the CBTS approach has a similar postoperative leg and back pain when compared to TTS although some of them reported less leg and back pain as regards CBTS. Oswestry Disability Index (ODI) and the operative time showed no significant differences between the CBTS and TTS. Radiological outcomes were similar in both procedures regarding fusion rates and vertebral slippage reduction. Blood loss during surgery was significantly less with CBTS compared to TTS. Conclusion: Both Oswestry Disability Index and operative time showed insignificant differences between the CBTS and TTS. Blood loss was significantly less with CBTS compared to TTS. Radiological outcomes were similar in both procedures. CBTS is a reasonable alternative technique to TTS in short segment posterior lumbar interbody fusion although the current literature did not prove its superiority. (2019ESJ197)   deformities and avoid non-union. Cortical Bony Trajectory screw (CBTS) is a new procedure in which screw follow an inferior to superior pathway in the sagittal plane and a medial to lateral pathway in the transverse plane. CBTS is reducing operative and post-operative complications and has high fixation strength. Purpose: To compare the clinical and radiological outcomes between CBTS and traditional trajectory screw (TTS) in surgical management of degenerative spondylolisthesis. Materials and Methods: comprehensive electronic search in PubMed, Cochrane library databases, Google scholar and Research gate for articles that published between 2009 to 2020 using these keywords: Cortical bony trajectory screw, cortical bony trajectory-pedicle screw, Pedicle screw, degenerative lumbar spondylolisthesis. Results: The majority of published data proves that the CBTS approach has a similar postoperative leg and back pain when compared to TTS, although some of them reported less leg and back pain in favor of CBTS. Regarding disability using oswesstry disability index (ODI) and the operative time showed no significant differences between the CBTS and TTS. Radiological outcomes are similar between both studies in bony fusion rates and vertebral reduction. Blood loss during surgery was significantly less with CBTS compared to TTS. Conclusion: Generally, no confirmed agreement regarding comparison of clinical outcomes and drawbacks between the CBTS and TTS approaches. Indications for CBTS and TTS are comparable between most researches, especially in surgical management of degenerative lumbar spondylolisthesis. Keywords: Cortical Bony Trajectory screw - Conventional Screw Trajectory – Degenerative Lumbar Spondylolisthesis

P137. A five-year review of hospital costs and reimbursement in the surgical management of degenerative spondylolisthesis

BACKGROUND CONTEXT Surgical management of degenerative spondylolisthesis (DS) with spinal stenosis (SS) remains controversial, as studies reveal that fusion technique may not affect outcomes. Various considerations may drive the decision to which type of fusion to use, including patient, surgeon and economic factors. PURPOSE This study was designed to characterize different charges, expenses, reimbursement, and hospital margins with non instrumented fusion in situ (PLF), posterolateral fusion with pedicle screws (PPS), and PPS with interbody device (PLIF). STUDY DESIGN/SETTING Retrospective chart review with corresponding financial audit. PATIENT SAMPLE All patients undergoing single level fusions from 2009-2014 based on ICD-9 diagnoses of DS and spinal stenosis. Multilevel fusions were excluded. OUTCOME MEASURES Primary outcome measures included all service and procedural charges (what was billed to insurance), expenses (direct costs incurred by the hospital), reimbursement, and margins that were obtained through the financial audit for each surgery and hospital stay. Overall reimbursement and margins were then calculated based on this data. METHODS A retrospective chart review was performed from 2010-2014 based on ICD-9 diagnoses of DS with SS in patients undergoing single level fusions. All service and procedural charges, expenses, hospital reimbursement, and hospital margins were obtained through the financial audit for each surgery and hospital stay. A multivariate linear regression model was used to compare patient demographics, charges, expenses, etc. A one-way analysis of variance (ANOVA) with Tukey post hoc analysis was used to analyze different reimbursements and margins based upon insurance types. RESULTS A total of 233 patients met inclusion criteria for the study. There were no significant differences with BMI, ASA class, length of stay or gender distribution. Both types of instrumented fusions had longer operating room times and estimated blood loss (P CONCLUSIONS As more instrumentation is used, the more it costs both the hospital (expenses) and the insurance company (charges). Hospital margins varied depending on both fusion method and insurance type. While charges, expenses and reimbursement tend to increase with instrumentation, hospital margins did not correspondingly. This study highlights the importance in better aligning the economic interests of all parties involved (patient, surgeon, hospital, insurance, etc.) in order to help control spending and transition to a more cost effective system. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

A 5-Year Review of Hospital Costs and Reimbursement in the Surgical Management of Degenerative Spondylolisthesis.

To evaluate charges, expenses, reimbursement, and hospital margins with noninstrumented posterolateral fusion in situ (PLF), posterolateral fusion with pedicle screws (PPS), and PPS with interbody device (PLIF) in degenerative spondylolisthesis with spinal stenosis. A retrospective chart review was performed from 2010 to 2014 based on ICD-9 diagnoses of degenerative spondylolisthesis with spinal stenosis in patients undergoing single-level fusions. All charges, expenses, reimbursement, and margins were obtained through financial auditing. A multivariate linear regression model was used to compare demographics, charges, etc. A 1-way analysis of variance with Tukey post hoc analysis was used to analyze reimbursements and margins based upon insurances. Two hundred thirty-three patients met inclusion criteria. The overall charges and expenses for PLF were significantly less compared to both types of instrumented fusions (P < .0001). Medicare and private insurance were the most common insurance types; Medicare and private insurance mean reimbursements for PLF were $36,903 and $47,086, respectively; for PPS, $37,450 and $53,851, and for PLIF $40,171 and $51,640. Hospital margins for PPS and PLIF in Medicaid patients were negative (-$3,702 and -$6,456). Hospital margins were largest for both worker's compensation and private insurance patients in all fusion groups. Hospital margins with Medicare for PLF, PPS, and PLIF were $24,347, $19,205, and $23,046, respectively. Hospital margins for private insurance for PLF, PPS, and PLIF were $37,569, $36,834, and $33,134, respectively. As more instrumentation is used, the more it costs both the hospital and the insurance companies; hospital margins did not increase correspondingly. Improved understanding of related costs and margins associated with lumbar fusions to help transition to more cost effective spine centers.

History of degenerative spondylolisthesis: From anatomical description to surgical management

This review of the historical medical literature aimed at understanding the evolution of surgical management of degenerative spondylolisthesis over time. The Medic@, IndexCat and Gallica historical databases and PubMed and Embase medical databases were used, with several search-terms, exploring the years 1700–2018. Data from anatomical, biomechanical, pathophysiological and surgical studies were compiled. In total, 150 documents were obtained, dating from 1782 to 2018: 139 from PubMed, 1 from Medic@, 7 from IndexCat, and 3 from Gallica. The review thus ranges in time from (1) description of the first clinical cases by several authors in Europe (1782), (2) the identification of a distinct entity by MacNab (1963), and (3) surgical management by the emerging discipline of minimally invasive spine surgery, to its subsequent evolution up to the present day. Spondylolisthesis is a frequent condition potentially responsible for a variety of functional impairments. Understanding and surgical management have progressed since the 20th century. Historically, the first descriptions of treatments concerned only spondylolisthesis associated with spondylolysis, especially in young adults. More recently, there has been progress in the understanding of the disease in elderly people, with the recognition of degenerative spondylolisthesis. New technologies and surgical techniques, aided by advances in supportive care, now provide spine surgeons with powerful treatment tools. Better knowledge of the evolution of surgery throughout history should enable better understanding of current approaches and concepts for treating degenerative spondylolisthesis.

Patient reported outcomes following surgery for degenerative spondylolisthesis: comparison of a universal and multi-tier health care system

STUDY DESIGNRetrospective review of results from a prospectively collected Canadian cohort in comparison to published literature. OBJECTIVES(1) To investigate whether patients in a universal health care system have different outcomes than those in a multitier health care system in surgical management of degenerative spondylolisthesis (DS).(2) To identify independent factors predictive of outcome in surgical DS patients. SUMMARY OF BACKGROUND DATACanada has a national health insurance program with unique properties. It is a single-payer system, coverage is universal, and access to specialist care requires referral by the primary care physician. The United States on the other hand is a multitier public/private payer system with more rapid access for insured patients to specialist care. METHODSSurgical DS patients treated between 2013 and 2016 in Canada were identified through the Canadian Spine Outcome Research Network (CSORN) database, a national registry that prospectively enrolls consecutive patients with spinal pathology from 16 tertiary care academic hospitals. This population was compared with the surgical DS arm of patients treated in the Spine Patients Outcome Research Trial (SPORT) study. We compared baseline demographics, spine-related, and health-related quality of life (HRQOL) outcomes at 3 months and 1 year. Multivariate analysis was used to identify factors predictive of outcome in surgical DS patients. RESULTSThe CSORN cohort of 213 patients was compared with the SPORT cohort of 248 patients. Patients in the CSORN cohort were younger (mean age 60.1 vs. 65.2; p<.001), comprised fewer females (60.1% vs. 67.7%; p=.09), and had a higher proportion of smokers (23.3% vs. 8.9%; p<.001). The SPORT cohort had more patients receiving compensation (14.6% vs. 7.7%; p<.001). The CSORN cohort consisted of patients with slightly greater baseline disability (Oswestry disability index scores: 47.7 vs. 44.0; p=.008) and had more patients with symptom duration of greater than 6 months (93.7% vs. 62.1%; p<.001). The CSORN cohort showed greater satisfaction with surgical results at 3 months (91.1% vs. 66.1% somewhat or very satisfied; p<.01) and 1 year (88.2% vs. 71.0%, p<.01). Improvements in back and leg pain were similar comparing the two cohorts. On multivariate analysis, duration of symptoms, treatment group (CSORN vs. SPORT) or insurance type (public/Medicare/Medicaid vs. Private/Employer) predicted higher level of postoperative satisfaction. Baseline depression was also associated with worse Oswestry disability index at 1-year postoperative follow-up in both cohorts. CONCLUSIONSSurgical DS patients treated in Canada (CSORN cohort) reported higher levels of satisfaction than those treated in the United States (SPORT cohort) despite similar to slightly worse baseline HRQOL measures. Symptom duration and insurance type appeared to impact satisfaction levels. Improvements in other patient-reported health-related quality of life measures were similar between the cohorts.

Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis.

Study Design:Systematic review and meta-analysis.Objective:Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS.Methods:This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study.Results:A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index (P = .29) and visual analog scale (P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss (P = .38), reoperation rate (P = .66), hospital stay (P = .96), complication rate (P = .78), or fusion rate (P = .15).Conclusions:There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.

Current Status of Lumbar Interbody Fusion for Degenerative Spondylolisthesis.

Instrumented lumbar fusion can provide immediate stability and assist in satisfactory arthrodesis in patients who have pain or instability of the lumbar spine. Lumbar adjunctive fusion with decompression is often a good procedure for surgical management of degenerative spondylolisthesis (DS). Among various lumbar fusion techniques, lumbar interbody fusion (LIF) has an advantage in that it maintains favorable lumbar alignment and provides successful fusion with the added effect of indirect decompression. This technique has been widely used and represents an advancement in spinal instrumentation, although the rationale and optimal type of LIF for DS remains controversial. We evaluated the current status and role of LIF in DS treatment, mainly as a means to augment instrumentation. We addressed the basic concept of LIF, its indications, and various types including minimally invasive techniques. It also has acceptable biomechanical features, and offers reconstruction with ideal lumbar alignment. Postsurgical adverse events related to each LIF technique are also addressed.

Surgical Management of Degenerative Spondylolisthesis

Surgical Management of Degenerative Spondylolisthesis

Predictors of outcomes after posterior decompression and fusion in degenerative spondylolisthesis.

No consensus has been reached regarding surgical management of degenerative spondylolisthesis. The optimal type of surgical procedure and surgical indications have not been precisely defined. In order to screen for predictors of outcome, we retrospectively studied patient outcomes after posterior decompression and fusion for isolated lumbar degenerative spondylolisthesis. Twenty-four consecutive patients (age range 50-78 years) underwent primary surgery for isolated lumbar degenerative spondylolisthesis. The surgical procedure consisted of posterior decompression and pedicle screw instrumented fusion using autogeneous bone graft, with or without interbody fusion. Clinical and radiologic status were assessed using the Beaujon functional score and plain AP and lateral radiographs. A multivariate analysis was used to correlate the functional score increase with surgical procedure modifications and preoperative clinical and radiologic features in order to determine which of them led to better results. Eighteen patients completed the evaluation. Six others were lost to follow-up after a minimum of 0.87 years. Combining all the results, the mean follow-up was 2.87 years. The Beaujon score was improved in the 24 patients (P<0.001), and fusion was successful in all cases. Additional interbody fusion and preoperative leg pain were significantly correlated with larger score increase (P=0.016 and P=0.003). Posterior decompression and fusion is successful in treating lumbar degenerative spondylolisthesis. From this study, circumferential fusion improves the outcomes and leg pain is a fair indication for surgery.

Decompression in the Surgical Management of Degenerative Spondylolisthesis

The management of degenerative spondylolisthesis with laminectomy alone or laminectomy with fusion remains controversial. From the early 1970s to 1996, 290 patients with degenerative spondylolisthesis were treated with 249 laminectomies and 41 fenestration procedures over an average of 3.2 levels. One level olisthesis was encountered in 250 patients, and two levels of slip in 40. Patients averaged 67 years of age, and were followed an average of 10 years. Using Prolo's outcome scale, 69% of patients exhibited excellent, 13% good, 12% fair, and 6% poor outcomes. Secondary decompressions with fusions for increased olisthy/instability (five patients) and recurrent stenosis/disc disease/instability (three patients) required one posterolateral "in situ" fusion and seven Texas Scottish Rite Hospital instrumented procedures. Decompression alone successfully managed degenerative spondylolisthesis in 290 patients treated over 3 decades, because only 8 (2.7%) required secondary fusion.

Decompression in the Surgical Management of Degenerative Spondylolisthesis

Decompression in the Surgical Management of Degenerative Spondylolisthesis