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  • Title: A review: Reduced reoperation rate for multilevel lumbar laminectomies with noninstrumented versus instrumented fusions.
    Author: Epstein NE.
    Journal: Surg Neurol Int; 2016; 7(Suppl 13):S337-46. PubMed ID: 27274408.
    Abstract:
    BACKGROUND: The reoperation rate, including for adjacent segment disease (ASD), is lower following multilevel lumbar laminectomy with noninstrumented versus instrumented fusions. METHODS: This study reviews selected literature focusing on the reoperation rate, including for ASD, following multilevel laminectomies with noninstrumented versus instrumented fusions. Several prior studies document a 1.3-5.6% reoperation rate following multilevel laminectomy with/without noninstrumented fusions. RESULTS: The reoperation rates for instrumented fusions, including for ASD, are substantially higher. One study cited a 12.2-18.5% frequency for reoperation following instrumented transforaminal lumbar and posterior lumbar interbody fusions (TLIF and PLIFs) at an average of 164 postoperative months. Another study cited a 9.9% reoperation rate for ASD 1 year following PLIF; this increased to 80% at 5 postoperative years. A further study compared 380 patients variously undergoing laminectomies/noninstrumented posterolateral fusions, laminectomies with instrumented fusions (PLFs), and laminectomies with instrumented PLF plus an interbody fusions; this study documented no significant differences in outcomes for any of these operations at 4 postoperative years. Furthermore, other series showed fusion rates for 1-2 level procedures which were often similar with or without instrumentation, while instrumentation increased reoperation rates and morbidity. CONCLUSIONS: Many studies document no benefit for adding instrumentation to laminectomies performed for degenerative disease, including spondylolisthesis. Reoperation rates for laminectomy alone/laminectomy with noninstrumented fusions vary from 1.3% to 5.6% whereas reoperation rates for ASD after instrumented PLIF was 80% at 5 postoperative years. This review should prompt spinal surgeons to reexamine when, why, and whether instrumentation is really necessary, particularly for treating degenerative lumbar disease.
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