1997 Volvo Award winner in clinical studies - Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation
1997 Volvo Award winner in clinical studies - Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation
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DOI：
10.1097/00007632-199712150-00003
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发表时间：
1997-12-15
期刊：
影响因子：
3
通讯作者：
Kurz, LT
中科院分区：
文献类型：
--
作者：
Fischgrund, JS;Mackay, M;Kurz, LT
研究设计。本前瞻性研究分析经椎弓根内固定对退行性椎体滑脱合并椎管狭窄患者手术治疗的影响。目的：探讨椎弓根内固定是否能改善椎管狭窄合并退行性椎体滑脱减压后行后外侧融合患者的临床疗效和融合率。摘要和背景。减压通常是治疗退行性椎体滑脱和椎管狭窄的有症状患者所必需的。最近的研究结果表明，如果在脱臼水平进行后外侧关节融合术，结果显着改善。文献荟萃分析得出结论，辅助脊柱内固定可以提高融合率，尽管对临床结果的影响尚不确定。前瞻性研究了76例伴有退行性腰椎滑脱的症状性椎管狭窄患者。所有患者均行后路减压合并后外侧横突间关节融合术。患者随机分为节段性经椎弓根固定组和非固定组。67名患者接受了为期2年的随访。76%置入内固定装置的患者和85%未置入内固定装置的患者的临床结果为优秀或良好（P = 0.45）。关节融合术的成功率为82%，而非器械融合术的成功率为45% （P = 0.0015）。总体而言，融合成功不影响患者预后（P = 0.435）。对于退行性椎体滑脱伴椎管狭窄的患者，行单节段后外侧融合术，使用椎弓根螺钉可提高融合率，但临床结果显示背部和下肢疼痛没有改善。
Study Design. This prospective study analyzed the influence of transpedicular instrumented on the operative treatment of patients with degenerative spondylolisthesis and spinal stenosis.Objectives. To determine whether the addition of transpedicular instrumented improves the clinical outcome and fusion rate of patients undergoing posterolateral fusion after decompression for spinal stenosis with concomitant degenerative spondylolisthesis.Summary and Background. Decompression is often necessary in the treatment of symptomatic patients who have degenerative spondylolisthesis and spinal stenosis. Results of recent studies demonstrated that outcomes are significantly improved if posterolateral arthrodesis is performed at the listhesed level. A meta-analysis of the literature concluded that adjunctive spinal instrumentation for this procedure can enhance the fusion rate, although the effect on clinical outcome remains uncertain.Methods. Seventy-six patients who had symptomatic spinal stenosis associated with degenerative lumbar spondylolisthesis were prospectively studied. All patients underwent posterior decompression with concomitant posterolateral intertransverse process arthrodesis. The patients were randomized to a segmental transpedicular instrumented or noninstrumented group.Results. Sixty-seven patients were available for a 2-year follow-up. Clinical outcome was excellent or good in 76% of the patients in whom instrumentation was placed and in 85% of those in whom no instrumentation was placed (P = 0.45). Successful arthrodesis occurred in 82% of the instrumented cases versus 45% of the nonistrumented cases (P = 0.0015). Overall, successful fusion did not influence patient outcome (P = 0.435).Conclusions. In patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws may lead to a higher fusion rate, but clinical outcome shows no improvement in pain in the back and lower limbs.