تدريب Shadowing: Decompression alone versus decompression with instrumented fusion in the t | Kaiser | EUROSPINE 2025 - تعلم التحدث بالإنجليزية عبر الفيديو

Good morning ladies and gentlemen.

So this study is from Czech Republic

and it's about decompression alone versus decompression with instrumented fusion in the treatment of a degenerative spondylolisthesis.

I have nothing to declare.

So this talk will be about minimally invasive surgery because MIS is not only about fancy tools and about new technologies,

but it's a concept of achieving the same outcome by using smaller approach and or less invasive procedure.

So we have various types of decompression, we have various types of fusion techniques,

but the main question remains whether it's necessary to fuse or to just decompress.

We all agree and we have enough data nowadays that so -called simple lumbar stenosis should be treated by simple decompression.

But what happens when we have a slip?

And how should be managed a patient where there are signs of instability,

although the instability is still not yet clearly defined in the literature?

So that's why we performed and designed a systematic review with meta -analysis

and this work was part of the development of Czech clinical practice guidelines, something similar to NICE guidelines in the UK,

the surgical treatment of the degenerative diseases of the spine

and the review was discussed and validated by a national panel of experts, six orthopedic surgeons and six neurosurgeons experienced in this topic.

And we incorporated only trials using pedicle screw fixation fusion and excluded those using other old techniques or non -instrumented fusion.

So the population was adults with degenerative lumbar spondylolisthesis.

We compared isolated decompression with decompression with pedicle screw fixation.

And primary outcomes were improvement in ODI and VAS in low back pain and leg pain.

And secondary outcomes, re -operation rate, complication rate, length of stay, duration of surgery, blood loss and quality of life.

And these are the basic results.

So we found only four randomized trials in the literature

and you have the comparison of the numbers between the two groups in each study.

The first one is the largest one, the most recent one, Austerwals study.

And we have enough or we had enough data for comparison.

However, you can see that the main problem was incorporation of dynamic or so -called dynamic instability in some of the studies.

So from 21 % to 42 % first didn't even measure the instability and only Gogovawa incorporated only stable stenosis.

So the results are quite clear.

There was no difference in ODI, back and leg pain between the two techniques at two -year follow -up in stable degenerative spondylolisthesis spondylolisthesis.

This is the most important statement because we couldn't do analysis for unstable spondylolisthesis.

And these results are confirmed even by follow -up studies with long -term results

and they found that there is no difference at 5

and 12 years follow -up between the risk of instability after simple decompression and risk of adjacent segment disease after the fusion.

And this is the current practice.

Although similar recommendations were already published before these trials by NAS,

for example, in 2016, they recommended decompression in symptomatic degenerative spondylolisthesis with maximum 20 % slip.

Or spinal section WFNS, decompression without instability and with dominant leg pain

but the current practice you can see below 62 % increase of fusions in the US of

which degenerative spondylolisthesis counted for 45 % with more than 100 % increase

and 40 % of spinal surgeons would always fuse every degenerative spondylolisthesis regardless of stability

and below are some other studies from from other countries

and you can see the proportion for example in a US study almost all patients with degenerative spondylolisthesis were fused.

So in conclusion, we can make a clear statement that decompression only should be recommended for isolated stable degenerative spondylolisthesis,

especially in higher age groups, but every case should be individually evaluated based on age of the patient,

general condition, signs of instability, sleep grade.

disc height, spinal deformity and dominant back pain over claudications.

So this study was published in the Journal of Neurology Neurosurgery

and Psychiatry and this meta -analysis was also part of this clinical practice guidelines which were published in the Czech Orthopaedic Journal.

Thank you very much.

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تدريب Shadowing: Decompression alone versus decompression with instrumented fusion in the t | Kaiser | EUROSPINE 2025 - تعلم التحدث بالإنجليزية عبر الفيديو

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