Current patterns of practice in spinal fusion for chronic low back pain-results from a survey at the German Spine Societies' Annual Congress 2018.
Chronic low back pain
Fusion
Indication
Lumbar
Spondylodesis
Survey
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
10
10
2020
accepted:
21
12
2020
pubmed:
7
1
2021
medline:
20
7
2021
entrez:
6
1
2021
Statut:
ppublish
Résumé
There is debate regarding criteria to select patients for lumbar fusion surgery who have chronic low back pain (CLBP) and corresponding degenerative changes, but without nerve root compression or neurogenic claudication. The aim of this study was to compare patterns in current practice. A total of 143 printed questionnaires containing 51 questions were distributed at the German Spine Societies' (DWG) annual congress, 6-8 December 2018. We received 127 (89%) surveys (64 orthopedic surgeons and 63 neurosurgeons). Excluding the 22% who do not perform lumbar fusion for CLBP, 41.4% reported performing 1-10 lumbar fusion procedures for patients with CLBP per year, 20.2% reported 11-20, 10.1% reported 21-30 and 17.2% reported performing more than 50. A total of 44.9% of surgeons reported treating patients for at least 6-12 months conservatively before considering surgery; 65.6% considered postoperative pain reduction of 50-70% a treatment success; 32.6% of respondents believe that <50% of patients showed good outcomes after fusion in CLBP and only 15.5% believed that 70% or more showed good outcomes. Orthopedic surgeons perform more lumbar fusion surgeries than neurosurgeons (p = 0.05), fuse more lumbar segments than neurosurgeons (p = 0.02) and are more likely to suggest that their patients with CLBP cease smoking preoperatively (p = 0.02). Despite discouraging evidence in the literature, the majority of respondents still perform fusion surgery in patients with CLBP. The use of preoperative diagnostics and tests vary widely among spine surgeons.
Sections du résumé
BACKGROUND
There is debate regarding criteria to select patients for lumbar fusion surgery who have chronic low back pain (CLBP) and corresponding degenerative changes, but without nerve root compression or neurogenic claudication. The aim of this study was to compare patterns in current practice.
METHOD
A total of 143 printed questionnaires containing 51 questions were distributed at the German Spine Societies' (DWG) annual congress, 6-8 December 2018.
RESULTS
We received 127 (89%) surveys (64 orthopedic surgeons and 63 neurosurgeons). Excluding the 22% who do not perform lumbar fusion for CLBP, 41.4% reported performing 1-10 lumbar fusion procedures for patients with CLBP per year, 20.2% reported 11-20, 10.1% reported 21-30 and 17.2% reported performing more than 50. A total of 44.9% of surgeons reported treating patients for at least 6-12 months conservatively before considering surgery; 65.6% considered postoperative pain reduction of 50-70% a treatment success; 32.6% of respondents believe that <50% of patients showed good outcomes after fusion in CLBP and only 15.5% believed that 70% or more showed good outcomes. Orthopedic surgeons perform more lumbar fusion surgeries than neurosurgeons (p = 0.05), fuse more lumbar segments than neurosurgeons (p = 0.02) and are more likely to suggest that their patients with CLBP cease smoking preoperatively (p = 0.02).
CONCLUSIONS
Despite discouraging evidence in the literature, the majority of respondents still perform fusion surgery in patients with CLBP. The use of preoperative diagnostics and tests vary widely among spine surgeons.
Identifiants
pubmed: 33404879
doi: 10.1007/s00701-020-04691-1
pii: 10.1007/s00701-020-04691-1
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
853-861Références
Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G, Pain CBWGGCLB (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15(Suppl 2):S192–S300. https://doi.org/10.1007/s00586-006-1072-1
doi: 10.1007/s00586-006-1072-1
pubmed: 16550448
pmcid: 3454542
Brox JI, Nygaard OP, Holm I, Keller A, Ingebrigtsen T, Reikeras O (2010) Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain. Ann Rheum Dis 69:1643–1648. https://doi.org/10.1136/ard.2009.108902
doi: 10.1136/ard.2009.108902
pubmed: 19635718
pmcid: 2938881
Chenot JF, Greitemann B, Kladny B, Petzke F, Pfingsten M, Schorr SG (2017) Non-Specific Low Back Pain. Dtsch Arztebl Int 114:883–890. https://doi.org/10.3238/arztebl.2017.0883
doi: 10.3238/arztebl.2017.0883
pubmed: 29321099
pmcid: 5769319
Datta S, Lee M, Falco FJ, Bryce DA, Hayek SM (2009) Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions. Pain Phys 12:437–460
Deyo RA, Bass JE (1989) Lifestyle and low-back pain. The influence of smoking and obesity. Spine (Phila Pa 1976) 14:501–506. https://doi.org/10.1097/00007632-198905000-00005
doi: 10.1097/00007632-198905000-00005
Fairbank J, Frost H, Wilson-MacDonald J, Yu LM, Barker K, Collins R, Spine Stabilisation Trial G (2005) Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ 330:1233. https://doi.org/10.1136/bmj.38441.620417.8F
doi: 10.1136/bmj.38441.620417.8F
pubmed: 15911537
pmcid: 558090
Fritzell P, Hagg O, Jonsson D, Nordwall A, Swedish Lumbar Spine Study G (2004) Cost-effectiveness of lumbar fusion and nonsurgical treatment for chronic low back pain in the Swedish Lumbar Spine Study: a multicenter, randomized, controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 29:421–434; discussion Z423. https://doi.org/10.1097/01.brs.0000102681.61791.12
doi: 10.1097/01.brs.0000102681.61791.12
Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Study G (2001) 2001 Volvo Award Winner in Clinical Studies: lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976) 26:2521–2532; discussion 2532-2524. https://doi.org/10.1097/00007632-200112010-00002
doi: 10.1097/00007632-200112010-00002
Low back pain and sciatica in over 16s: assessment and management, NICE guideline [NG59] (2016) National Institute for Health and Care Excellence (NICE), https://www.nice.org.uk/guidance/ng59 . Accessed 06 Jan 2021
Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS (2019) Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015. Spine (Phila Pa 1976) 44:369–376. https://doi.org/10.1097/BRS.0000000000002822
doi: 10.1097/BRS.0000000000002822
Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S, Takaso M, Kuniyoshi K, Aoki Y, Ishikawa T, Arai G, Miyagi M, Kamoda H, Suzuki M, Nakamura J, Toyone T, Takahashi K (2011) Surgical versus nonsurgical treatment of selected patients with discogenic low back pain: a small-sized randomized trial. Spine (Phila Pa 1976) 36:347–354. https://doi.org/10.1097/BRS.0b013e3181d0c944
doi: 10.1097/BRS.0b013e3181d0c944
Staal JB, de Bie RA, de Vet HC, Hildebrandt J, Nelemans P (2009) Injection therapy for subacute and chronic low back pain: an updated Cochrane review. Spine (Phila Pa 1976) 34:49–59. https://doi.org/10.1097/BRS.0b013e3181909558
doi: 10.1097/BRS.0b013e3181909558
Todd NV (2017) The surgical treatment of non-specific low back pain. Bone Joint J 99-B:1003–1005. https://doi.org/10.1302/0301-620X.99B8.BJJ-2017-0199.R1
doi: 10.1302/0301-620X.99B8.BJJ-2017-0199.R1
pubmed: 28768775
van Tulder MW, Assendelft WJ, Koes BW, Bouter LM (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976) 22:427–434. https://doi.org/10.1097/00007632-199702150-00015
doi: 10.1097/00007632-199702150-00015
Watters WC 3rd, Resnick DK, Eck JC, Ghogawala Z, Mummaneni PV, Dailey AT, Choudhri TF, Sharan A, Groff MW, Wang JC, Dhall SS, Kaiser MG (2014) Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine 21:79–90. https://doi.org/10.3171/2014.4.SPINE14281
doi: 10.3171/2014.4.SPINE14281
pubmed: 24980590
Willems P (2013) Decision making in surgical treatment of chronic low back pain: the performance of prognostic tests to select patients for lumbar spinal fusion. Acta Orthop Suppl 84:1–35. https://doi.org/10.3109/17453674.2012.753565
doi: 10.3109/17453674.2012.753565
pubmed: 23427903
Willems P, de Bie R, Oner C, Castelein R, de Kleuver M (2011) Clinical decision making in spinal fusion for chronic low back pain. Results of a nationwide survey among spine surgeons. BMJ Open 1:e000391. https://doi.org/10.1136/bmjopen-2011-000391
doi: 10.1136/bmjopen-2011-000391
pubmed: 22189352
pmcid: 3278483
Willems PC, Staal JB, Walenkamp GH, de Bie RA (2013) Spinal fusion for chronic low back pain: systematic review on the accuracy of tests for patient selection. Spine J 13:99–109. https://doi.org/10.1016/j.spinee.2012.10.001
doi: 10.1016/j.spinee.2012.10.001
pubmed: 23127364
Wilson-MacDonald J, Fairbank J, Frost H, Yu LM, Barker K, Collins R, Campbell H, Spine Stabilization Trial G (2008) The MRC spine stabilization trial: surgical methods, outcomes, costs, and complications of surgical stabilization. Spine (Phila Pa 1976) 33:2334–2340. https://doi.org/10.1097/BRS.0b013e318186a8b2
doi: 10.1097/BRS.0b013e318186a8b2