Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: Lumbar fusion for stenosis without spondylolisthesis
Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 10: Lumbar fusion for stenosis without spondylolisthesis
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DOI：
10.3171/2014.4.spine14275
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发表时间：
2014-07-01
影响因子：
2.8
通讯作者：
Kaiser, Michael G.
中科院分区：
文献类型：
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作者：
Resnick, Daniel K.;Watters, William C., III;Kaiser, Michael G.
腰椎管狭窄症是一种常见的影像学表现的老化过程中，导致狭窄的椎管和椎间孔。当狭窄与临床相关时，患者通常描述与活动相关的下背部或下肢疼痛，称为神经源性跛行。对于那些保守治疗没有改善的患者，手术被认为是一种适当的治疗选择。手术的主要目的是重建椎管。在没有退行性畸形的情况下，融合的作用尚不确定。之前的指南建议在没有脊柱不稳或可能有医源性不稳的情况下不纳入腰椎融合术。自最初的指南发表以来，许多研究已经证明了手术减压在该患者人群中的作用;然而，很少有人研究融合在无潜在不稳定患者中的效用。大多数研究包含异质性受试者队列，通常合并接受各种手术干预的脊椎前移和非脊椎前移患者，限制了不稳定患者的融合。因此，很难（如果不是不可能的话）得出关于融合术在无并发症狭窄患者中的效用的有效结论。然而，存在较低水平的证据，不能证明融合对这些患者有额外的受益;因此，在没有畸形或不稳定的情况下，不建议纳入融合。
Lumbar stenosis is one of the more common radiographic manifestations of the aging process, leading to narrowing of the spinal canal and foramen. When stenosis is clinically relevant, patients often describe activity-related low-back or lower-extremity pain, known as neurogenic claudication. For those patients who do not improve with conservative care, surgery is considered an appropriate treatment alternative. The primary objective of surgery is to reconstitute the spinal canal. The role of fusion, in the absence of a degenerative deformity, is uncertain. The previous guideline recommended against the inclusion of lumbar fusion in the absence of spinal instability or a likelihood of iatrogenic instability. Since the publication of the original guidelines, numerous studies have demonstrated the role of surgical decompression in this patient population; however, few have investigated the utility of fusion in patients without underlying instability. The majority of studies contain a heterogeneous cohort of subjects, often combining patients with and without spondylolisthesis who received various surgical interventions, limiting fusions to those patients with instability. It is difficult if not impossible, therefore, to formulate valid conclusions regarding the utility of fusion for patients with uncomplicated stenosis. Lower-level evidence exists, however, that does not demonstrate an added benefit of fusion for these patients; therefore, in the absence of deformity or instability, the inclusion of a fusion is not recommended.