Co-author Alfred J. Pisano, MD selects the 5 most intriguing findings from the recently published “What’s New in Spine Surgery.”
Cervical Spondylotic Myelopathy
– A recent randomized clinical trial compared outcomes following anterior vs. posterior surgery in patients with cervical spondylotic myelopathy1. One and two-year SF-36 Physical Component Summary scores did not differ between the groups. However, a higher complication rate was found for the anterior surgery cohort. The rates of major complications did not differ between the groups. In the nonrandomized analysis, physical function, complication rate, and resource utilization were better for patients with laminoplasty compared with posterior or anterior cervical fusion.
– Other researchers2 posed the question: is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? This was a retrospective, multicenter analysis of 264 patients. Group I included 168 patients with fusion ending at C6/7. Group II included 96 patients with fusion ending at T1/2. Patient-reported outcomes improved equally in the groups. In addition, radiographic outcomes were similar. Group II had greater blood loss and operative time.
– Another study3 found no difference in reoperation rates for adjacent segment disease when cervical fusions were ended at C7 or T1/2.
Lumbar Degenerative Spondylolisthesis
– Investigators evaluated patients with lumbar degenerative spondylolisthesis with a slip of ≥3 mm. Patients were randomized to either decompression alone or decompression and fusion4. At 2 years, a similar proportion of patients had a clinically important improvement in the ODI score: 71.4% in the decompression-only group and 72.9% in the decompression and fusion group. The reoperation rate was higher in the decompression-only group, but not significantly so (12.5% vs. 9.1%).
Single-Position Lumbar Fusion
– A systematic review and meta-analysis evaluated the current evidence for single-position lumbar fusion for patients with lumbar degenerative disease, spondylolisthesis, or radiculopathy5. The analysis found less operative time and radiation exposure for the single-position lateral decubitus position compared with the prone single position.
“What’s New in Spine Surgery” is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org.
- Ghogawala Z, Terrin N, Dunbar MR, Breeze JL, Freund KM, Kanter AS, Mummaneni PV, Bisson EF, Barker FG 2nd, Schwartz JS, Harrop JS, Magge SN, Heary RF, Fehlings MG, Albert TJ, Arnold PM, Riew KD, Steinmetz MP, Wang MC, Whitmore RG, Heller JG, Benzel EC. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial. JAMA. 2021 Mar 9;325(10):942-51.
- Truumees E, Singh D, Lavelle W, Riesenburger R, Geck M, Kurra S, Yu A, Grits D, Dowd R, Winkelman R, Mroz T, Stokes J. Is it safe to stop at C7 during multilevel posterior cervical decompression and fusion? – Multicenter analysis. Spine J. 2021 Jan;21(1):90-5.
- Guppy KH, Royse KE, Fennessy J, Norheim EP, Harris JE, Brara HS. No difference in reoperation rates for adjacent segment disease (operative adjacent segment disease) in posterior cervical fusions stopping at C7 versus T1/T2: a cohort of 875 patients-part 1. Spine (Phila Pa 1976). 2022 Feb 1;47(3):261-8.
- Austevoll IM, Hermansen E, Fagerland MW, Storheim K, Brox JI, Solberg T, Rekeland F, Franssen E, Weber C, Brisby H, Grundnes O, Algaard KRH, Böker T, Banitalebi H, Indrekvam K, Hellum C; NORDSTEN-DS Investigators. Decompression with or without fusion in degenerative lumbar spondylolisthesis. N Engl J Med. 2021 Aug 5;385(6):526-38.
- Mills ES, Treloar J, Idowu O, Shelby T, Alluri RK, Hah RJ. Single position lumbar fusion: a systematic review and meta-analysis. Spine J. 2022 Mar;22(3):429-43.