Grob Mannion
Fakultäten » Medizinische Fakultät » Rheumaklinik und Institut für physikalische Medizin » PD Dr. Anne Mannion » Grob Mannion
Completed research project
| Title / Titel | A prospective, cohort study of two lumbar fusion techniques. | ||||
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| Abstract (PDF, 14 KB) | |||||
| Summary / Zusammenfassung | Introduction Numerous types of fusion technique prevail; little evidence exists for the superiority of any one over another. This prospective cohort study compared outcomes after fusion with translaminar screws (TS) versus transforaminal lumbar interbody fusion plus pedicular fixation (TLIF). Methods The study was nested within our SSE Spine Tango data acquisition system, using the multidimensional Core Outcome Measures Index (COMI) before and 12 months after surgery. Inclusion criteria: monosegmental/bisegmental degenerative disc disease, facet syndrome, or degenerative spondylolisthesis; German-speaking; no previous surgery (except discectomy). Each surgeon consistently used his/her same chosen method for the given indications, for all his/her patients. Results 121 patients participated; 57 in the TS group (1 surgeon) and 64 in the TLIF group (4 surgeons). Gender distribution was identical in the two groups (67% women); TS were older than TLIF (67±10y and 56±15y respectively, p<0.05). No group differences existed for baseline COMI scores (all p>0.05). TS had a lower operation duration (p=0.0001) and blood-loss (p=0.01) but a longer hospital stay (p=0.005) than TLIF. Complication rates were similar in each group (2-4%). 94% patients returned questionnaires at 12mo. The groups did not differ in: COMI score reduction, 3.5±2.9 (TS) vs 4.1±2.6 (TLIF)(p=0.23); “good” global outcomes, 72% (TS) vs 77% (TLIF)(p=0.58); satisfaction with treatment, 82% (TS) vs 88% (TLIF)(p=0.36). Discussion This cohort study showed similar subjective results after 1yr for two different surgical techniques, done for identical indications, but with differing surgical time, invasiveness and implant costs. The data suggest that, for these degenerative disorders, optimal but invasive three-point stabilization is not required to achieve satisfactory results. Although, the study design is not the highest in the “hierarchy-of-evidence”, it includes every single eligible patient and allows each surgeon to use his regular surgical procedure; it hence represents a practicable, complementary approach to the randomised-controlled-trial, with higher external validity (relevance/generalisability). | ||||
| Publications / Publikationen | Grob D, Mannion AF, Lattig F, Kleinstück FS, Bartanusz V, Jeszenszky D (2008) A prospective, cohort study of two lumbar fusion techniques. International Society for the Study of the Lumbar Spine (Spine Week), Geneva, Switzerland, 26.5.08-31.5.08Grob D, Mannion AF, Lattig F, Kleinstück FS, Bartanusz V, Jeszenszky D (2008) Might less be more in lumbar fusion surgery? A prospective, cohort study of two fusion techniques. Schweizerische Gesellschaft für Orthopädie. Basel, Switzerland, 24-26-9.2008. Swiss Medical Forum 8 (Suppl 44):S25Grob D, Bartanusz V, Jeszenszky D, Kleinstueck FS, Lattig F, O'Riordan D, Mannion AF (2009) A prospective, cohort study comparing translaminar screw fixation with transforaminal lumbar interbody fusion and pedicle screw fixation for fusion of the degenerate lumbar spine. JBJS (Br) 91(10):1347-53 | ||||
| Keywords / Suchbegriffe | lumbar fusion, spine surgery, outcome, translaminar fixation, TLIF | ||||
| Project leadership and contacts / Projektleitung und Kontakte |
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| Funding source(s) / Unterstützt durch |
Foundation Stiftung Wilhelm Schulthess Forschungsfonds |
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| Duration of Project / Projektdauer | Dec 2006 to Dec 2009 |