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73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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Decompression with or without Fusion in degenerative adjacent segment stenosis after lumbar fusions

Dekompression im Vergleich zur Dekompression mit Fusion zur Behandlung von lumbalen Anschlussstenosen

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  • presenting/speaker Anton Früh - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Patrick Leißa - Universität Witten/Herdecke, Witten, Deutschland
  • Dimitri Tkatschenko - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Peter Vajkoczy - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
  • Simon Bayerl - Charité – Universitätsmedizin Berlin, Klinik für Neurochirurgie, Berlin, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV031

doi: 10.3205/22dgnc039, urn:nbn:de:0183-22dgnc0393

Published: May 25, 2022

© 2022 Früh et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Adjacent segment stenosis can occur after lumbar fusion surgery, leading to significant discomfort and pain. If further surgeries are required, the choice of the operative technique is an individual decision. It is still uncertain whether patients with adjacent spinal stenosis without obvious instability should be treated via decompressive surgery alone or decompression and fusion.

Methods: We included patients with adjacent segment stenosis after lumbar fusion. Patients with spinal deformity and/or obvious instability were excluded. All patients were divided into two groups according to the surgical technique, that has been used: (1) treated via microsurgical decompression (MDG), (2) decompression and fusion of the adjacent segment (FG). Primary outcome was the need for further lumbar surgery. Patient reported outcome was measured via Numerical Rating Scale (NRS), SF-36, Oswestry disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI) and Allgemeine Depressions Skala before surgery and after 1 year.

Results: 36 patients with a median age of 72 years were included. 86.1 % of patients suffered from a proximal adjacent segment stenosis and most common level was LWK3/4 (50 %). 61.1 % of included patients developed adjacent segment stenosis after fusion of one single lumbar segment. 16 patients were included in MDG and 20 patients in FG. Both groups benefited from surgical decompression and there was no significant difference concerning Outcome scores after 1 year or the need of follow-up surgeries (3 in MDG vs. 5 in FG, p = 0.439). In the MDG the Health-related Quality of life (ΔSF-36-KSK = 3.9 (0.4-5.8); ΔSF-36-PSK = 3.4 (-0.3-7.7) and sleeping quality improved (ΔPSQI = -1 (-5-0)). Pain decreased (ΔNRS = -3 (-7-0)) and pain associated disability index decreased from severe disability (ODIMDG,priorsurgery = 51 (34-58)) to moderate disability (ODIMDG,followup = 30 (14-46)).

Conclusion: The present study indicates that decompression may not be inferior to decompression and fusion in patients suffering from degenerative adjacent segment stenosis without obvious signs of instability after lumbar fusion in short-term follow-up. However, long term-results are pending.