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      Pacific Spine and Pain Society (PSPS) Evidence Review of Surgical Treatments for Lumbar Degenerative Spinal Disease: A Narrative Review

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          Abstract

          Introduction

          Interventional treatment options for the lumbar degenerative spine have undergone a significant amount of innovation over the last decade. As new technologies emerge, along with the surgical specialty expansion, there is no manuscript that utilizes a review of surgical treatments with evidence rankings from multiple specialties, namely, the interventional pain and spine communities. Through the Pacific Spine and Pain Society (PSPS), the purpose of this manuscript is to provide a balanced evidence review of available surgical treatments.

          Methods

          The PSPS Research Committee created a working group that performed a comprehensive literature search on available surgical technologies for the treatment of the degenerative spine, utilizing the ranking assessment based on USPSTF (United States Preventative Services Taskforce) and NASS (North American Spine Society) criteria.

          Results

          The surgical treatments were separated based on disease process, including treatments for degenerative disc disease, spondylolisthesis, and spinal stenosis.

          Conclusions

          There is emerging and significant evidence to support multiple approaches to treat the symptomatic lumbar degenerative spine. As new technologies become available, training, education, credentialing, and peer review are essential for optimizing patient safety and successful outcomes.

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          Most cited references93

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          Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF.

          Degenerative disc and facet joint disease of the lumbar spine is common in the ageing population, and is one of the most frequent causes of disability. Lumbar spondylosis may result in mechanical back pain, radicular and claudicant symptoms, reduced mobility and poor quality of life. Surgical interbody fusion of degenerative levels is an effective treatment option to stabilize the painful motion segment, and may provide indirect decompression of the neural elements, restore lordosis and correct deformity. The surgical options for interbody fusion of the lumbar spine include: posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), minimally invasive transforaminal lumbar interbody fusion (MI-TLIF), oblique lumbar interbody fusion/anterior to psoas (OLIF/ATP), lateral lumbar interbody fusion (LLIF) and anterior lumbar interbody fusion (ALIF). The indications may include: discogenic/facetogenic low back pain, neurogenic claudication, radiculopathy due to foraminal stenosis, lumbar degenerative spinal deformity including symptomatic spondylolisthesis and degenerative scoliosis. In general, traditional posterior approaches are frequently used with acceptable fusion rates and low complication rates, however they are limited by thecal sac and nerve root retraction, along with iatrogenic injury to the paraspinal musculature and disruption of the posterior tension band. Minimally invasive (MIS) posterior approaches have evolved in an attempt to reduce approach related complications. Anterior approaches avoid the spinal canal, cauda equina and nerve roots, however have issues with approach related abdominal and vascular complications. In addition, lateral and OLIF techniques have potential risks to the lumbar plexus and psoas muscle. The present study aims firstly to comprehensively review the available literature and evidence for different lumbar interbody fusion (LIF) techniques. Secondly, we propose a set of recommendations and guidelines for the indications for interbody fusion options. Thirdly, this article provides a description of each approach, and illustrates the potential benefits and disadvantages of each technique with reference to indication and spine level performed.
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            A Randomized, Controlled Trial of Fusion Surgery for Lumbar Spinal Stenosis.

            The efficacy of fusion surgery in addition to decompression surgery in patients who have lumbar spinal stenosis, with or without degenerative spondylolisthesis, has not been substantiated in controlled trials.
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              Laminectomy plus Fusion versus Laminectomy Alone for Lumbar Spondylolisthesis.

              The comparative effectiveness of performing instrumented (rigid pedicle screws affixed to titanium alloy rods) lumbar spinal fusion in addition to decompressive laminectomy in patients with symptomatic lumbar grade I degenerative spondylolisthesis with spinal stenosis is unknown.
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                Author and article information

                Contributors
                lee.davidw@gmail.com
                Journal
                Pain Ther
                Pain Ther
                Pain and Therapy
                Springer Healthcare (Cheshire )
                2193-8237
                2193-651X
                23 March 2024
                23 March 2024
                June 2024
                : 13
                : 3
                : 349-390
                Affiliations
                [1 ]GRID grid.19006.3e, ISNI 0000 0000 9632 6718, Department of Neurosurgery, , UCLA, ; Westlake Village, CA USA
                [2 ]Spanish Hills Interventional Pain Specialists, Camarillo, CA USA
                [3 ]Evolve Restorative Center, ( https://ror.org/00e8gtn74) Santa Rosa, CA USA
                [4 ]Fullerton Orthopedic Surgery Medical Group, Fullerton, CA USA
                [5 ]GRID grid.416759.8, ISNI 0000 0004 0460 3124, Sutter Health System, ; Roseville, CA USA
                [6 ]Department of Neurosurgery, UC Irvine, ( https://ror.org/04gyf1771) Orange, CA USA
                [7 ]GRID grid.489291.f, Total Spine Institute, ; Los Angeles, CA USA
                [8 ]Neurosurgical Associates of Lancaster, Lancaster, PA USA
                [9 ]California Orthopedics and Spine, Novato, CA USA
                Article
                588
                10.1007/s40122-024-00588-4
                11111626
                38520658
                c1ddc90e-fb95-4ea0-aedb-d561b7abd23d
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 29 October 2023
                : 19 February 2024
                Categories
                Review
                Custom metadata
                © Springer Healthcare Ltd., part of Springer Nature 2024

                degenerative spine disease,spinal stenosis,spondylolisthesis,lumbar fusion,minimally invasive spine

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