Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials - PubMed (original) (raw)

Review

Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials

Choon Sung Lee et al. Clin Orthop Surg. 2011 Mar.

Abstract

Background: Lumbar spine fusion rates can vary according to the surgical technique. Although many studies on spinal fusion have been conducted and reported, the heterogeneity of the study designs and data handling make it difficult to identify which approach yields the highest fusion rate. This paper reviews studies that compared the lumbosacral fusion rates achieved with different surgical techniques.

Methods: Relevant randomized trials comparing the fusion rates of different surgical approaches for instrumented lumbosacral spinal fusion surgery were identified through highly sensitive and targeted keyword search strategies. A methodological quality assessment was performed according to the checklist suggested by the Cochrane Collaboration Back Review Group. Qualitative analysis was performed.

Results: A literature search identified six randomized controlled trials (RCTs) comparing the fusion rates of different surgical approaches. One trial compared anterior lumbar interbody fusion (ALIF) plus adjunctive posterior transpedicular instrumentation with circumferential fusion and posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF). Three studies compared PLF with circumferential fusion. One study compared three fusion approaches: PLF, PLIF and circumferential fusion.

Conclusions: One low quality RCT reported no difference in fusion rate between ALIF with posterior transpedicular instrumentation and circumferential fusion, and PLIF and circumferential fusion. There is moderate evidence suggesting no difference in fusion rate between PLF and PLIF. The evidence on the fusion rate of circumferential fusion compared to PLF from qualitative analysis was conflicting. However, no general conclusion could be made due to the scarcity of data, heterogeneity of the trials included, and some methodological defects of the six studies reviewed.

Keywords: Spinal fusion; Surgical approach; Systematic review.

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Conflict of interest statement

The authors have no potential conflicts of interest relevant to this article.

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References

    1. DiPaola CP, Molinari RW. Posterior lumbar interbody fusion. J Am Acad Orthop Surg. 2008;16(3):130–139. - PubMed
    1. Penta M, Fraser RD. Anterior lumbar interbody fusion: a minimum 10-year follow-up. Spine (Phila Pa 1976) 1997;22(20):2429–2434. - PubMed
    1. Humphreys SC, Hodges SD, Patwardhan AG, Eck JC, Murphy RB, Covington LA. Comparison of posterior and transforaminal approaches to lumbar interbody fusion. Spine (Phila Pa 1976) 2001;26(5):567–571. - PubMed
    1. Christensen FB, Hansen ES, Eiskjaer SP, et al. Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine (Phila Pa 1976) 2002;27(23):2674–2683. - PubMed
    1. Fritzell P, Hagg O, Wessberg P, Nordwall A Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila Pa 1976) 2002;27(11):1131–1141. - PubMed

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