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dc.contributor.authorHellum, Christian
dc.contributor.authorRekeland, Frode Gurvin
dc.contributor.authorSmåstuen, Milada Cvancarova
dc.contributor.authorSolberg, Tore
dc.contributor.authorHermansen, Erland
dc.contributor.authorStorheim, Kjersti
dc.contributor.authorBrox, Jens Ivar
dc.contributor.authorFurunes, Håvard
dc.contributor.authorFranssen, Eric
dc.contributor.authorWeber, Clemens
dc.contributor.authorBrisby, Helena
dc.contributor.authorGrundnes, Oliver
dc.contributor.authorRobert Hector Algaard, Knut
dc.contributor.authorBøker, Tordis
dc.contributor.authorBanitalebi, Hasan
dc.contributor.authorIndrekvam, Kari
dc.contributor.authorAustevoll, Ivar Magne
dc.date.accessioned2023-10-25T09:06:55Z
dc.date.available2023-10-25T09:06:55Z
dc.date.created2023-06-23T09:08:08Z
dc.date.issued2023
dc.identifier.citationHellum, C., Rekeland, F., Småstuen, M.C., Solberg, T., Hermansen, E., Storheim, K., Brox, J.I., Furunes, H, Franssen, E. Weber, C., Brisby, H. Grundnes, O., Aalgaard, K.R.H., Böker, T., Banitalebi, H., Indrekvam, K., Austevoll, I. (2023) Surgery in degenerative spondylolisthesis: does fusion improve outcome in subgroups? A secondary analysis from a randomized trial (NORDSTEN trial). The Spine Journal, 23(11), 1613-1622en_US
dc.identifier.issn1529-9430
dc.identifier.urihttps://hdl.handle.net/11250/3098625
dc.description.abstractBACKGROUND CONTEXT Patients with spinal stenosis and degenerative spondylolisthesis are treated surgically with decompression alone or decompression with fusion. However, there is debate regarding which subgroups of patients may benefit from additional fusion. PURPOSE To investigate possible treatment effect modifiers and prognostic variables among patients operated for spinal stenosis and degenerative spondylolisthesis. DESIGN A secondary exploratory study using data from the Norwegian Degenerative Spondylolisthesis and Spinal Stenosis (NORDSTEN-DS) trial. Patients were randomized to decompression alone or decompression with instrumented fusion. PATIENT SAMPLE The sample in this study consists of 267 patients from a randomized multicenter trial involving 16 hospitals in Norway. Patients were enrolled from February 12, 2014, to December 18, 2017. The study did not include patients with degenerative scoliosis, severe foraminal stenosis, multilevel spondylolisthesis, or previous surgery. OUTCOME MEASURES The primary outcome was an improvement of ≥ 30% on the Oswestry Disability Index score (ODI) from baseline to 2-year follow-up. METHODS When investigating possible variables that could modify the treatment effect, we analyzed the treatment arms separately. When testing for prognostic factors we analyzed the whole cohort (both treatment groups). We used univariate and multiple regression analyses. The selection of variables was done a priori, according to the published trial protocol. RESULTS Of the 267 patients included in the trial (183 female [67%]; mean [SD] age, 66 [7.6] years), complete baseline data for the variables required for the present analysis were available for 205 of the 267 individuals. We did not find any clinical or radiological variables at baseline that modified the treatment effect. Thus, none of the commonly used criteria for selecting patients for fusion surgery influenced the chosen primary outcome in the two treatment arms. For the whole cohort, less comorbidity (American Society of Anesthesiologists Classification [ASA], OR = 4.35; 95% confidence interval (CI [1.16–16.67]) and more preoperative leg pain (OR = 1.23; CI [1.02–1.50]) were significantly associated with an improved primary outcome. CONCLUSIONS In this study on patients with degenerative spondylolisthesis, neither previously defined instability criteria nor other pre-specified baseline variables were associated with better clinical outcome if fusion surgery was performed. None of the analyzed variables can be applied to guide the decision for fusion surgery in patients with degenerative spondylolisthesis. For both treatment groups, less comorbidity and more leg pain were associated with improved outcome 2 years after surgery.en_US
dc.language.isoengen_US
dc.publisherElsevier Ltd.en_US
dc.rightsNavngivelse 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/deed.no*
dc.subjectkirurgien_US
dc.subjectdegenerativ spondylolisteseen_US
dc.titleSurgery in Degenerative Spondylolisthesis: Does fusion improve outcome in subgroups? A secondary analysis from a randomized trial (NORDSTEN trial)en_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.rights.holder© 2023 The Author(s)en_US
dc.subject.nsiVDP::Medisinske Fag: 700::Klinisk medisinske fag: 750en_US
dc.source.volume23en_US
dc.source.journalThe spine journalen_US
dc.source.issue11en_US
dc.identifier.doi10.1016/j.spinee.2023.06.386
dc.identifier.cristin2157304
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1


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Navngivelse 4.0 Internasjonal
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