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Decompression alone...
Decompression alone or decompression with fusion for lumbar spinal stenosis : a randomized clinical trial with two-year MRI follow-up
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- Karlsson, Thomas (författare)
- Uppsala universitet,Ortopedi,Uppsala Univ Hosp, Spine Sect, Orthopaed Clin, Uppsala, Sweden.
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- Försth, Peter, 1966- (författare)
- Uppsala universitet,Ortopedi,Uppsala Univ Hosp, Spine Sect, Orthopaed Clin, Uppsala, Sweden.
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- Skorpil, M. (författare)
- Karolinska Institutet
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- Pazarlis, Konstantinos A. (författare)
- Uppsala universitet,Ortopedi,Stockholm Spine Ctr, Upplands Väsby, Sweden.
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- Öhagen, Patrik (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR)
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- Michaëlsson, Karl, 1959- (författare)
- Uppsala universitet,Medicinsk epidemiologi
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- Sandén, Bengt (författare)
- Uppsala universitet,Ortopedi,Uppsala Univ Hosp, Spine Sect, Orthopaed Clin, Uppsala, Sweden.
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(creator_code:org_t)
- The British Editorial Society of Bone & Joint Surgery, 2022
- 2022
- Engelska.
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Ingår i: The Bone & Joint Journal. - : The British Editorial Society of Bone & Joint Surgery. - 2049-4394 .- 2049-4408. ; 104B:12, s. 1343-1351
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- Aims: The aims of this study were first, to determine if adding fusion to a decompression of the lumbar spine for spinal stenosis decreases the rate of radiological restenosis and/or proximal adjacent level stenosis two years after surgery, and second, to evaluate the change in vertebral slip two years after surgery with and without fusion.Methods: The Swedish Spinal Stenosis Study (SSSS) was conducted between 2006 and 2012 at five public and two private hospitals. Six centres participated in this two--year MRI follow--up. We randomized 222 patients with central lumbar spinal stenosis at one or two adjacent levels into two groups, decompression alone and decompression with fusion. The presence or absence of a preoperative spondylolisthesis was noted. A new stenosis on two--year MRI was used as the primary outcome, defined as a dural sac cross--sectional area = 75 mm2 at the operated level (restenosis) and/or at the level above (proximal adjacent level stenosis).Results: A total of 211 patients underwent surgery at a mean age of 66 years (69% female): 103 were treated by decompression with fusion and 108 by decompression alone. A two--year MRI was available for 176 (90%) of the eligible patients. A new stenosis at the operated and/or adjacent level occurred more frequently after decompression and fusion than after decompression alone (47% vs 29%; p = 0.020). The difference remained in the subgroup with a preoperative spondylolisthesis, (48% vs 24%; p = 0.020), but did not reach significance for those without (45% vs 35%; p = 0.488). Proximal adjacent level stenosis was more common after fusion than after decompression alone (44% vs 17%; p < 0.001). Restenosis at the operated level was less frequent after fusion than decompression alone (4% vs 14%; p = 0.036). Vertebral slip increased by 1.1 mm after decompression alone, regardless of whether a preoperative spondylolisthesis was present or not.Conclusion: Adding fusion to a decompression increased the rate of new stenosis on two--year MRI, even when a spondylolisthesis was present preoperatively. This supports decompression alone as the preferred method of surgery for spinal stenosis, whether or not a degenerative spondylolisthesis is present preoperatively.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Ortopedi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Orthopaedics (hsv//eng)
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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