单纯减压术与减压融合术比较治疗退行性腰椎疾病的系统评价
|
摘要
目的：系统评价单纯减压术与减压融合术两种手术方式的优劣。方法：①计算机检索MEDLINE(OVID，1966～2006．4)、EMBASE(1984～2006．4)、CBM(1978～2005．12)、万方数据库(1981～2006．4)、Cochrane图书馆(2006年第1期)、中文科技期刊数据库(VIP，1989～2006．4)：②手工检索相关杂志。纳入单纯减压和减压+融合两种手术方式治疗退行性腰椎疾病且随访大于2年的随机对照试验和半随机对照试验并进行质量评价。而后采用RevMan4．2．8软件对可以合并分析的指标作Meta分析；对不能合并的指标用描述性方法分析结果。结果：有7篇研究符合纳入标准，共412例。Meta分析结果显示：单纯减压和减压+融合两种手术方式治疗退行性腰椎疾病在总体疗效[OR1.83，95％CI(0.92，3.41)]、疼痛减轻程度[术前 WMD0.12，95％CI(-0.44，0.68)；术后WMD 0.08，95％CI(-1.08，1.25)]、术后腿痛人数[OR 1.04，95％CI(0.48，2.25)]、术后随访期二次手术人数[OR 0.68，95％CI(0.30，1.56)]和围手术期并发症[OR1.15，95％CI(0.51，2.60)]等方面，其差异均无统计学意义；但两组在术后腰痛的发生人数上，差异有统计学意义[OR 0.25，95％CI(0.14，0.46)]。有4个研究比较了手术时间、术中失血、术后腰部使用支具固定时间、住院总的费用，结果表明，单纯减压手术组少于减压融合组。有3个研究比较了术前、术后椎体过伸过屈位滑移程度、手术间隙终板成角，术前术后椎间隙高度变化与手术疗效的关系，但不同研究的结果矛盾。结论：单纯减压和减压+融合两种手术方式治疗退行性腰椎疾病在总体疗效、疼痛减轻程度、
Objictive: To evaluat the effectiveness of decompression with and without fusion in treating degenerative lumbar disease. Methods: We searched The Cochrane Library (Issue 1, 2006), Medline(1966 to Apr, 2006), EMBASE(1984 to Apr 2006), the China Biological Medcine Datdbase (till Dec, 2005), VIP(1989 to Apr, 2006), and several related journal were searched by hand for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) on the comparison of the outcomes between decompression with and without fusion in treating degenerative lumbar disease. The quality of included trials was critically appraised. RevMan 4.2.8 soft-ware was used for statistical analysis the figures which could be combined. Other informations be described in the outcomes. Results: Seven Published studies with 412 participants were included. The results of Meta-analysis indicate that there have no statistical significance in cumulative clinical outcome (OR1.83, 95%CI (0.92, 3.41)、 Postoperative cumulative leg pain rate(OR 1.04, 95%CI (0.48, 2.25)、 cumulative complications rate(OR 1.15, 95%CI (0.51, 2.60), cumulative reoperation rate(OR 0.68, 95%CI (0.30, 1.56) or cumulative preoperative score and postoperative score [Preo WMD 0.12, 95%CI (-0.44, 0.68); Posto WMD 0.08,95%CI (-1.08,1.25)] between the two operative methods. The only statistical significance is the postoperative cumulative back pain rate[OR 0.25, 95%CI(0.14,0.46)].
Objictive: To evaluat the effectiveness of decompression with and without fusion in treating degenerative lumbar disease. Methods: We searched The Cochrane Library (Issue 1, 2006), Medline(1966 to Apr, 2006), EMBASE(1984 to Apr 2006), the China Biological Medcine Datdbase (till Dec, 2005), VIP(1989 to Apr, 2006), and several related journal were searched by hand for randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) on the comparison of the outcomes between decompression with and without fusion in treating degenerative lumbar disease. The quality of included trials was critically appraised. RevMan 4.2.8 soft-ware was used for statistical analysis the figures which could be combined. Other informations be described in the outcomes. Results: Seven Published studies with 412 participants were included. The results of Meta-analysis indicate that there have no statistical significance in cumulative clinical outcome (OR1.83, 95%CI (0.92, 3.41)、 Postoperative cumulative leg pain rate(OR 1.04, 95%CI (0.48, 2.25)、 cumulative complications rate(OR 1.15, 95%CI (0.51, 2.60), cumulative reoperation rate(OR 0.68, 95%CI (0.30, 1.56) or cumulative preoperative score and postoperative score [Preo WMD 0.12, 95%CI (-0.44, 0.68); Posto WMD 0.08,95%CI (-1.08,1.25)] between the two operative methods. The only statistical significance is the postoperative cumulative back pain rate[OR 0.25, 95%CI(0.14,0.46)].
引文
[1] Grobe d, Humke, Dvorak J (1995) Degenerative lumbar soinal stenosis. Decompression with and without arthrodesis. J Bone Joint Surg 77A:1036-1041
[2] Rompe JD, Eysel p, Hopf C, Heine J (1995) Surgical management of central lumbar spinal stenosis-results with decompressive laminectomy only and with concomitant instrumented fusion with the Cotrel-Dubousset-Instrumentation. Neuroorthopedics 19:17-31
[3] Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrosis in degenerative lumbar spinal stenosis. Spine 22:1123-1131
[4] The Cochrane Collaboration. cochrane reviewers Handbook 4.2.3 [R]. http:// www. cochraneeye.Org /documents/ Cochrane%-20 Reviewers% 20 Handbook % 204.2.3.pdf.
[5] The Cochrane Collaboration. RevMan 4.2 User Guide [R]. http://www.cc-ims.net/down load/ revman/ Documentation-/User% 20guide. pdf.
[6] Paul A. Vauhan, Barry W. Malcolm, Gianni. Maistrelli. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion.Spine,1988, 13:690-5
[7] Ko.Matsudairy, Taksshi Yamazaki, Atsushi Seichi. Spinal Stenosis in Grade I Degenerative Lumbar Spondylolisthsis: a Comparative Study of Outcomes Following Laminoplasty and Laminectomy with Instrumented Spinal fusion. J Orthop Sci (2005)10:270-276
[8] Takeshima, Toshichika, Kambara, Kanji. Clinical and
Radiographic Evaluation of Disc Herniation With and Without Posterlateral fusion.Spine,2000, 25(4):450-456
[9] Arthur H.White, Peter Von Rogov, James Zucherman, David Heiden. Lumbar Laminectomy for Herniated Disc:A Prospective Controlled Comparison with Internal Fixation Fusion.Spine,1987,12(3):305-307
[10] Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg 1991;73A:802-8
[11] Harris RI, MacnabI. Structural changes in lumbar intervertebral disc:their relationship tolow back pain and sciatica.J Bone Joint Surg [Br] 1954;36:304-22
[12] Kirkaldy-Willis WH,Farfan HF.Instability of the lumbar spine. Clin Ortho 1982;165:110-23
[13] Spratt KF,Weinstein JN,Lehmann TR,et al. Efficacy of Flexion and Extension Treatments Incorporating Brace for Low Back Pain Patients with Retrodisplacement, Spondylolisthesis, or Normal Sagital Translation. Spine, 1993,81:716-730
[14] Hanley EN, Matteri RE, Frymoyer JM. Accurate roentgenographic determination of lumbar flexion-extension. Clin Orthop 1976:115:145-8
[15] Bjarke Christensen, Stender Hansen, Laursen, Malene; Thomsen Karsten et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine 2002;27:1269-1277
[1] Iguchi T, Wakami T, Kurihara A, et al. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 2002;15:93-9
[2] Imada K, Matsui H, Tsuji H. Oophorectomy predisposes to degenerative spondylolisthesis. J Bone Joint Surg Br 1995;77:126-30
[3] Dai LY. Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis. Int Orthop 2001;25:40-2
[4] Boden SD, Riew KD, Yamaguchi K, et al. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am 1996:78:403-11
[5] Grobler LJ, Robertson PA, Novotny JE, et al. Etiology of spondylol isthesis: assessment of the role played by lumbar facet joint morphology. Spine 1993:18:80-91
[6] Sato K, Wakamatsu E, Yoshizumi A, et al. The configuration of the laminas and facet joints in degenerative spondylolisthesis: a clinicoradiologic study. Spine 1989;14: 1265-71
[7] Rosenberg NJ. Degenerative spondylolisthesis: predisposing factors. J Bone Joint Surg Am 1975;57:467-74
[8] Rothman SL, Glenn WV Jr, Kerber CW. Multiplanar CT in the evaluation of degenerative spondylolisthesis: a review of 150 cases. Comput Radiol 1985;9:223-32
[9] Herkowitz HN. Spine update: degenerative lumbar spondylolisthesis. Spine 1995:20:1084-90
[10] Matsunaga S, Sakou T, Morizono Y, et al. Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine 1990:15:1204-10
[11] Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976;115:149-56
[12] Fairbank JC, Park WM, McCall IW, et al. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine 1981:6:598-605
[13] Helbig T, Lee CK. The lumbar facet syndrome. Spine 1988:13:61-4
[14] Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints: is the lumbar facet syndrome a clinical entity? Spine 1994;19:1132-7
[15] Dreyfuss PH, Dreyer SJ. Lumbar zygapophysial (facet) joint injections. Spine J 2003;3(suppl):50-9
[16] McNally DS, Adams MA. Internal intervertebral disc mechanics as revealed by stress profilometry. Spine 1992;17:66-73
[17] McNally DS, Shackleford IM, Goodship AE, et al. In vivo stress measurement can predict pain on discography. Spine 1996:21:2580-7
[18] Frymoyer JW, Krag MH. Spinal stability and instability: definitions, classification, and general principles of management. In: Dunsker SB, Schmidek HH, Frymoyer JW, et al. eds. The Unstable Spine. Orlando, FL: Grune & Stratton, 1986
[19] Pope MH, Panjabi M. Biomechanical definitions of spinal instability. Spine 1985:10:255-6
[20] Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982:165:110-23
[21] McGregor AH, Anderton L, Gedroyc WM, et al. The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine 2002:27:1582-6
[22] Sengupta DK. Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am 2004:35:43-56
[23] Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003:13:371-9
[24] Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10-to 18-year follow-up study. J Neurosurg 2000:93:194-8
[25] Johnsson K-E,Rosen I, Uden A.The natural course of lumbar spinal stenosis.Clin Ortho Rel Res 1992:279:82-6
[26] Bjarke Christensen, Stender Hansen, Laursen, Malene; Thomsen Karsten et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine 2002:27:1269-1277
[27] Lombardi JS, Wiltse LL, Reynolds J, et al. Treatment of degenerative spondylolisthesis. Spine 1985:10:821-7
[28] Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine 1986:11:107-10
[29] Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991:73:802-8
[30] Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 1992:74:862-9
[31] Deyo RA, Ciol MA, Cherkin DC, Loeser JD, Bigos SJ. Lumbar spinal fusion: A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 1993:18:1463-70
[32] Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. J Bone Joint Surg 1992;74A:536-43
[33] Zdeblick TA. A prospective, randomized study of lumbar fusion: preliminary results. Spine 1993:18:983-91
[34] Bridwell KH, Sedgewick TA, O' Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993:6:461-72
[35] Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis: a meta-analysis of literature 1970-1993. Spine 1994; 19(suppl) :2256-65
[36] Yuan HA, Garfin SR, Dickman CA, et al. A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spinal fusions. Spine 1994;19(suppl):2279-96
[37] Rechtine GR, Sutterlin CE, Wood GW, et al. The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis. J Spinal Disord 1996:9:382-91
[38] Fischgrund JS, Mackay M, Herkowitz HN, et al. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997:22:2807-12
[39] Grob D, Jumke T, Dvorak J. Degenerative lumbar spinal stenosis: Decompression with and without arthrodesis. J Bone Joint Surg 1995;77A:1036-41
[40] Kornblum MB, Fischgrund J, Herkowitz H, et al. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion with pseudoarthrosis. Spine In press
[41] Inoue S, Watanabe T, Goto S, et al. Degenerative spondylolisthesis: pathophysiology and results of anterior interbody fusion. Clin Orthop 1988;227:90-8
[42] Satomi K, Hirabayashi K, Toyama Y, et al. A clinical study of degenerative spondylolisthesis: radiographic analysis and choice of treatment. Spine 1992:17:1329-36
[43] Montgomery DM, Fischgrund JS. Passive reduction of spondylolisthesis on the operating room table: a prospective study. J Spinal Disord 1994:7:167-72
[44] Bednar DA. Surgical management of lumbar degenerative spinal stenosis with spondylolisthesis via posterior reduction with minimal laminectomy. J Spinal Disord Tech 2002:15:105-9
[45] Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine 2002:27:59-64
[46] Gibson JN, Waddell G, Grant IC. Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev 2000: CD001352
[47] Fritzell P, Hagg O, Wessberg P, et al. 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 2002;27:1131-41
[48] Phillips FM. The argument for noninstrumented posterolateral fusion for patients with spinal stenosis and degenerative spondylolisthesis. Spine 2004:29:170-2
[49] Kimura I, Shingu H, Murata M, et al. Lumbar posterolateral fusion alone or with transpedicular instrumentation in L4 - L5 degenerative spondylolisthesis. J Spinal Disord 2001:14:301-10
[50] Katz JN, Lipson SJ, Lew RA, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis: patient selection, costs, and surgical outcomes. Spine 1997:22:1123-31
[51] Kuntz KM, Snider RK, Weinstein JN, et al. Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Spine 2000;25: 1132-9
[52] Shah RR, Mohammed S, Saifuddin A, et al. Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine. Spine 2003:28:272-5
[53] Fischgrund JS. The argument for instrumented decompressive posterolateral fusion for patients with degenerative spondylolisthesis and spinal stenosis. Spine 2004:29:173-4
[54] Johnsson R, Stromqvist B, Aspenberg P. Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo Award in clinical studies. Spine 2002:27:2654-61
[55] Vaccaro AR, Patel T, Fischgrund J, et al. A pilot safety and efficacy study of 0P-1 putty (rhBMP-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions. Eur Spine J 2003
[56] Polly DW Jr, Ackerman SJ, Shaffrey CI, et al. A cost analysis of bone morphogenetic protein versus autogenous iliac crest bone graft in single-level anterior lumbar fusion. Orthopedics 2003;26:1027-37
[57] Graf H. Lumbar instability: surgical treatment without fusion. Rachis 1992:412:123-37
[58] Konno S, Kikuchi S. Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with Graf system stabilization. Spine 2000;25:1533-7
[59] Davis H. Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990. Spine 1994;19: 1117-24
[2] Rompe JD, Eysel p, Hopf C, Heine J (1995) Surgical management of central lumbar spinal stenosis-results with decompressive laminectomy only and with concomitant instrumented fusion with the Cotrel-Dubousset-Instrumentation. Neuroorthopedics 19:17-31
[3] Katz JN, Lipson SJ, Lew RA, Grobler LJ, Weinstein JN, Brick GW, Fossel AH, Liang MH (1997) Lumbar laminectomy alone or with instrumented or noninstrumented arthrosis in degenerative lumbar spinal stenosis. Spine 22:1123-1131
[4] The Cochrane Collaboration. cochrane reviewers Handbook 4.2.3 [R]. http:// www. cochraneeye.Org /documents/ Cochrane%-20 Reviewers% 20 Handbook % 204.2.3.pdf.
[5] The Cochrane Collaboration. RevMan 4.2 User Guide [R]. http://www.cc-ims.net/down load/ revman/ Documentation-/User% 20guide. pdf.
[6] Paul A. Vauhan, Barry W. Malcolm, Gianni. Maistrelli. Results of L4-L5 Disc Excision Alone Versus Disc Excision and Fusion.Spine,1988, 13:690-5
[7] Ko.Matsudairy, Taksshi Yamazaki, Atsushi Seichi. Spinal Stenosis in Grade I Degenerative Lumbar Spondylolisthsis: a Comparative Study of Outcomes Following Laminoplasty and Laminectomy with Instrumented Spinal fusion. J Orthop Sci (2005)10:270-276
[8] Takeshima, Toshichika, Kambara, Kanji. Clinical and
Radiographic Evaluation of Disc Herniation With and Without Posterlateral fusion.Spine,2000, 25(4):450-456
[9] Arthur H.White, Peter Von Rogov, James Zucherman, David Heiden. Lumbar Laminectomy for Herniated Disc:A Prospective Controlled Comparison with Internal Fixation Fusion.Spine,1987,12(3):305-307
[10] Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg 1991;73A:802-8
[11] Harris RI, MacnabI. Structural changes in lumbar intervertebral disc:their relationship tolow back pain and sciatica.J Bone Joint Surg [Br] 1954;36:304-22
[12] Kirkaldy-Willis WH,Farfan HF.Instability of the lumbar spine. Clin Ortho 1982;165:110-23
[13] Spratt KF,Weinstein JN,Lehmann TR,et al. Efficacy of Flexion and Extension Treatments Incorporating Brace for Low Back Pain Patients with Retrodisplacement, Spondylolisthesis, or Normal Sagital Translation. Spine, 1993,81:716-730
[14] Hanley EN, Matteri RE, Frymoyer JM. Accurate roentgenographic determination of lumbar flexion-extension. Clin Orthop 1976:115:145-8
[15] Bjarke Christensen, Stender Hansen, Laursen, Malene; Thomsen Karsten et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine 2002;27:1269-1277
[1] Iguchi T, Wakami T, Kurihara A, et al. Lumbar multilevel degenerative spondylolisthesis: radiological evaluation and factors related to anterolisthesis and retrolisthesis. J Spinal Disord Tech 2002;15:93-9
[2] Imada K, Matsui H, Tsuji H. Oophorectomy predisposes to degenerative spondylolisthesis. J Bone Joint Surg Br 1995;77:126-30
[3] Dai LY. Orientation and tropism of lumbar facet joints in degenerative spondylolisthesis. Int Orthop 2001;25:40-2
[4] Boden SD, Riew KD, Yamaguchi K, et al. Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am 1996:78:403-11
[5] Grobler LJ, Robertson PA, Novotny JE, et al. Etiology of spondylol isthesis: assessment of the role played by lumbar facet joint morphology. Spine 1993:18:80-91
[6] Sato K, Wakamatsu E, Yoshizumi A, et al. The configuration of the laminas and facet joints in degenerative spondylolisthesis: a clinicoradiologic study. Spine 1989;14: 1265-71
[7] Rosenberg NJ. Degenerative spondylolisthesis: predisposing factors. J Bone Joint Surg Am 1975;57:467-74
[8] Rothman SL, Glenn WV Jr, Kerber CW. Multiplanar CT in the evaluation of degenerative spondylolisthesis: a review of 150 cases. Comput Radiol 1985;9:223-32
[9] Herkowitz HN. Spine update: degenerative lumbar spondylolisthesis. Spine 1995:20:1084-90
[10] Matsunaga S, Sakou T, Morizono Y, et al. Natural history of degenerative spondylolisthesis: pathogenesis and natural course of the slippage. Spine 1990:15:1204-10
[11] Mooney V, Robertson J. The facet syndrome. Clin Orthop 1976;115:149-56
[12] Fairbank JC, Park WM, McCall IW, et al. Apophyseal injection of local anesthetic as a diagnostic aid in primary low-back pain syndromes. Spine 1981:6:598-605
[13] Helbig T, Lee CK. The lumbar facet syndrome. Spine 1988:13:61-4
[14] Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints: is the lumbar facet syndrome a clinical entity? Spine 1994;19:1132-7
[15] Dreyfuss PH, Dreyer SJ. Lumbar zygapophysial (facet) joint injections. Spine J 2003;3(suppl):50-9
[16] McNally DS, Adams MA. Internal intervertebral disc mechanics as revealed by stress profilometry. Spine 1992;17:66-73
[17] McNally DS, Shackleford IM, Goodship AE, et al. In vivo stress measurement can predict pain on discography. Spine 1996:21:2580-7
[18] Frymoyer JW, Krag MH. Spinal stability and instability: definitions, classification, and general principles of management. In: Dunsker SB, Schmidek HH, Frymoyer JW, et al. eds. The Unstable Spine. Orlando, FL: Grune & Stratton, 1986
[19] Pope MH, Panjabi M. Biomechanical definitions of spinal instability. Spine 1985:10:255-6
[20] Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982:165:110-23
[21] McGregor AH, Anderton L, Gedroyc WM, et al. The use of interventional open MRI to assess the kinematics of the lumbar spine in patients with spondylolisthesis. Spine 2002:27:1582-6
[22] Sengupta DK. Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am 2004:35:43-56
[23] Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003:13:371-9
[24] Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10-to 18-year follow-up study. J Neurosurg 2000:93:194-8
[25] Johnsson K-E,Rosen I, Uden A.The natural course of lumbar spinal stenosis.Clin Ortho Rel Res 1992:279:82-6
[26] Bjarke Christensen, Stender Hansen, Laursen, Malene; Thomsen Karsten et al. Long-Term Functional Outcome of Pedicle Screw Instrumentation as a Support for Posterolateral Spinal Fusion: Randomized Clinical Study With a 5-Year Follow-up. Spine 2002:27:1269-1277
[27] Lombardi JS, Wiltse LL, Reynolds J, et al. Treatment of degenerative spondylolisthesis. Spine 1985:10:821-7
[28] Johnsson KE, Willner S, Johnsson K. Postoperative instability after decompression for lumbar spinal stenosis. Spine 1986:11:107-10
[29] Herkowitz HN, Kurz LT. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 1991:73:802-8
[30] Postacchini F, Cinotti G. Bone regrowth after surgical decompression for lumbar spinal stenosis. J Bone Joint Surg Br 1992:74:862-9
[31] Deyo RA, Ciol MA, Cherkin DC, Loeser JD, Bigos SJ. Lumbar spinal fusion: A cohort study of complications, reoperations, and resource use in the Medicare population. Spine 1993:18:1463-70
[32] Deyo RA, Cherkin DC, Loeser JD, Bigos SJ, Ciol MA. Morbidity and mortality in association with operations on the lumbar spine. J Bone Joint Surg 1992;74A:536-43
[33] Zdeblick TA. A prospective, randomized study of lumbar fusion: preliminary results. Spine 1993:18:983-91
[34] Bridwell KH, Sedgewick TA, O' Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord 1993:6:461-72
[35] Mardjetko SM, Connolly PJ, Shott S. Degenerative lumbar spondylolisthesis: a meta-analysis of literature 1970-1993. Spine 1994; 19(suppl) :2256-65
[36] Yuan HA, Garfin SR, Dickman CA, et al. A historical cohort study of pedicle screw fixation in thoracic, lumbar, and sacral spinal fusions. Spine 1994;19(suppl):2279-96
[37] Rechtine GR, Sutterlin CE, Wood GW, et al. The efficacy of pedicle screw/plate fixation on lumbar/lumbosacral autogenous bone graft fusion in adult patients with degenerative spondylolisthesis. J Spinal Disord 1996:9:382-91
[38] Fischgrund JS, Mackay M, Herkowitz HN, et al. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine 1997:22:2807-12
[39] Grob D, Jumke T, Dvorak J. Degenerative lumbar spinal stenosis: Decompression with and without arthrodesis. J Bone Joint Surg 1995;77A:1036-41
[40] Kornblum MB, Fischgrund J, Herkowitz H, et al. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective long-term study comparing fusion with pseudoarthrosis. Spine In press
[41] Inoue S, Watanabe T, Goto S, et al. Degenerative spondylolisthesis: pathophysiology and results of anterior interbody fusion. Clin Orthop 1988;227:90-8
[42] Satomi K, Hirabayashi K, Toyama Y, et al. A clinical study of degenerative spondylolisthesis: radiographic analysis and choice of treatment. Spine 1992:17:1329-36
[43] Montgomery DM, Fischgrund JS. Passive reduction of spondylolisthesis on the operating room table: a prospective study. J Spinal Disord 1994:7:167-72
[44] Bednar DA. Surgical management of lumbar degenerative spinal stenosis with spondylolisthesis via posterior reduction with minimal laminectomy. J Spinal Disord Tech 2002:15:105-9
[45] Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine 2002:27:59-64
[46] Gibson JN, Waddell G, Grant IC. Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev 2000: CD001352
[47] Fritzell P, Hagg O, Wessberg P, et al. 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 2002;27:1131-41
[48] Phillips FM. The argument for noninstrumented posterolateral fusion for patients with spinal stenosis and degenerative spondylolisthesis. Spine 2004:29:170-2
[49] Kimura I, Shingu H, Murata M, et al. Lumbar posterolateral fusion alone or with transpedicular instrumentation in L4 - L5 degenerative spondylolisthesis. J Spinal Disord 2001:14:301-10
[50] Katz JN, Lipson SJ, Lew RA, et al. Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis: patient selection, costs, and surgical outcomes. Spine 1997:22:1123-31
[51] Kuntz KM, Snider RK, Weinstein JN, et al. Cost-effectiveness of fusion with and without instrumentation for patients with degenerative spondylolisthesis and spinal stenosis. Spine 2000;25: 1132-9
[52] Shah RR, Mohammed S, Saifuddin A, et al. Radiologic evaluation of adjacent superior segment facet joint violation following transpedicular instrumentation of the lumbar spine. Spine 2003:28:272-5
[53] Fischgrund JS. The argument for instrumented decompressive posterolateral fusion for patients with degenerative spondylolisthesis and spinal stenosis. Spine 2004:29:173-4
[54] Johnsson R, Stromqvist B, Aspenberg P. Randomized radiostereometric study comparing osteogenic protein-1 (BMP-7) and autograft bone in human noninstrumented posterolateral lumbar fusion: 2002 Volvo Award in clinical studies. Spine 2002:27:2654-61
[55] Vaccaro AR, Patel T, Fischgrund J, et al. A pilot safety and efficacy study of 0P-1 putty (rhBMP-7) as an adjunct to iliac crest autograft in posterolateral lumbar fusions. Eur Spine J 2003
[56] Polly DW Jr, Ackerman SJ, Shaffrey CI, et al. A cost analysis of bone morphogenetic protein versus autogenous iliac crest bone graft in single-level anterior lumbar fusion. Orthopedics 2003;26:1027-37
[57] Graf H. Lumbar instability: surgical treatment without fusion. Rachis 1992:412:123-37
[58] Konno S, Kikuchi S. Prospective study of surgical treatment of degenerative spondylolisthesis: comparison between decompression alone and decompression with Graf system stabilization. Spine 2000;25:1533-7
[59] Davis H. Increasing rates of cervical and lumbar spine surgery in the United States, 1979-1990. Spine 1994;19: 1117-24