Evidence-Based Recommendations for Spine Surgery

Alexander R. Vaccaro, MD, PhD, MBA; Charles G. Fisher, MD; Srinivas K. Prasad, MD; Alpesh A. Patel, MD, FACS; John Chi, MD, MPH; Kishore Mulpuri, MBBS, MHSc; Kenneth C. Thomas, MD, MHSc; Peter G. Whang, MD, FACS


Spine. 2020;45(21):E1441-E1448. 

In This Article

Study Summary

This study included 72 subjects between the ages of 40 and 60 years with symptomatic lumbar stenosis with or without spondylolisthesis and no osteoporosis as confirmed by DEXA scans who were randomly assigned to undergo PLIF with bilateral polyetheretherketone cages filled with local autograft/demineralized bone matrix and either PS (n = 37) or CS (n = 35). The baseline characteristics of the two cohorts were equivalent but both cohorts included a surprisingly high percentage of smokers (35% for PS, 43% for CS); also of interest is that the patients were hospitalized for 14 days after their surgeries. The primary endpoint was the fusion status which was determined from both dynamic radiographs and computed tomography. The authors also assessed other secondary measures including back pain and leg pain indicated on the VAS, ODI, and 12-Item Short-Form Health Survey scores, patient satisfaction, complications, and other radiographic outcomes.

At 2 years, the fusion rates for the CS and PS groups were equivalent (94.5% for PS, 94.3% for CS). Although VAS back pain scores were significantly lower with CS at 1 week which was attributed to the reduced muscle dissection required of this technique, they were comparable at all other time points. Similarly, patient satisfaction was significantly greater in the CS cohort at 1 month, but the rates had equalized by 1 year. Otherwise, there were no significant differences observed between the CS and PS groups in terms of the other secondary clinical outcomes, radiographic findings, and complications at any of the time points throughout the entire follow-up period. Based upon these findings, the authors conclude that CS may be considered to be a viable alternative to PS for providing adjunctive segmental fixation for PLIF constructs.