BACKGROUND

Degenerative spondylolisthesis (DS) is one of the most common pathologies spine surgeons treat. While a number of potential factors have been identified, there is no current consensus on which variables most impact the decision to fuse vs. decompress alone in this population.

PURPOSE

The purpose of this study was to describe current DS treatment practices and identify both the radiographic and clinical factors leading to the decision to fuse segments for one level DS.

STUDY DESIGN/SETTING

Descriptive cross-sectional survey.

PATIENT SAMPLE

Surveys were administered to members of Lumbar Spine Research Society and Society of Minimally Invasive Spine Surgery.

OUTCOME MEASURES

Surgeon demographics and treatment practices were reported. Radiographic and clinical parameters were ranked by each surgeon with regards to their importance.

METHODS

The primary analysis was limited to completed surveys. Baseline characteristics were summarized. Clinical and radiographic parameters were ranked and compared. Ranking of each clinical and radiographic parameters was reported using best and worst rank, mean rank position, and percentiles. The most important, top 3 most important, and top 5 most important parameters were ordered given each parameter's ranking frequency.

RESULTS

381 surveys were returned completed. With regards to fusion vs. decompression, 19.9% fuse all cases, 39.1% fuse > 75%, 17.8% fuse 50%–75%, and 23.2% fuse <25%. The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). 82.2% of respondents instrument all fusion cases. Instability (93.2%), spondylolisthesis grade (59.8%), and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. With regards to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%), and neurogenic claudication (42.8%) were the top 3 clinical parameters.

CONCLUSIONS

There is little consensus on the treatment of DS, with society members showing substantial variation in treatment patterns with the majority utilizing fusion for treatment. The most common radiographic parameters impacting treatment are instability, spondylolisthesis grade, and laterolisthesis while mechanical low back pain, activity level, and neurogenic claudication are the most common clinical parameters.

中文翻译：

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导致单节段退行性脊柱滑脱融合与减压的当前治疗和决策因素：来自腰椎研究学会和微创脊柱外科学会成员的调查结果

背景

退行性脊椎滑脱 (DS) 是脊柱外科医生治疗的最常见病症之一。虽然已经确定了许多潜在因素，但目前还没有就哪些变量最能影响该人群中融合与单独减压的决定达成共识。

目的

本研究的目的是描述当前的 DS 治疗实践，并确定导致决定为一级 DS 融合节段的放射学和临床因素。

研究设计/设置

描述性横断面调查。

患者样本

对腰椎研究学会和微创脊柱外科学会的成员进行了调查。

结果测量

报告了外科医生的人口统计资料和治疗实践。每位外科医生根据其重要性对射线照相和临床参数进行排名。

方法

The primary analysis was limited to completed surveys. Baseline characteristics were summarized. Clinical and radiographic parameters were ranked and compared. Ranking of each clinical and radiographic parameters was reported using best and worst rank, mean rank position, and percentiles. The most important, top 3 most important, and top 5 most important parameters were ordered given each parameter's ranking frequency.

RESULTS

381 surveys were returned completed. With regards to fusion vs. decompression, 19.9% fuse all cases, 39.1% fuse > 75%, 17.8% fuse 50%–75%, and 23.2% fuse <25%. The most common decompressive technique was a partial laminotomy (51.4%), followed by full laminectomy (28.9%). 82.2% of respondents instrument all fusion cases. Instability (93.2%), spondylolisthesis grade (59.8%), and laterolisthesis (37.3%) were the most common radiographic factors impacting the decision to fuse. With regards to the clinical factors leading to fusion, mechanical low back pain (83.2%), activity level (58.3%), and neurogenic claudication (42.8%) were the top 3 clinical parameters.

CONCLUSIONS

对 DS 的治疗几乎没有达成共识，社会成员在治疗模式上表现出很大差异，其中大多数人采用融合治疗。影响治疗的最常见放射学参数是不稳定性、脊椎前移等级和侧滑，而机械性腰痛、活动水平和神经源性跛行是最常见的临床参数。