Development of appropriateness criteria for the surgical treatment of symptomatic lumbar degenerative spondylolisthesis (LDS).

Détails

ID Serval
serval:BIB_6F2578F02229
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Development of appropriateness criteria for the surgical treatment of symptomatic lumbar degenerative spondylolisthesis (LDS).
Périodique
European Spine Journal
Auteur⸱e⸱s
Mannion A.F., Pittet V., Steiger F., Vader J.P., Becker H.J., Porchet F.
Collaborateur⸱rice⸱s
Zürich Appropriateness of Spine Surgery (ZASS) Group
ISSN
1432-0932 (Electronic)
ISSN-L
0940-6719
Statut éditorial
Publié
Date de publication
2014
Peer-reviewed
Oui
Volume
23
Numéro
9
Pages
1903-1917
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
PURPOSE: Spine surgery rates are increasing worldwide. Treatment failures are often attributed to poor patient selection and inappropriate treatment, but for many spinal disorders there is little consensus on the precise indications for surgery. With an aging population, more patients with lumbar degenerative spondylolisthesis (LDS) will present for surgery. The aim of this study was to develop criteria for the appropriateness of surgery in symptomatic LDS.
METHODS: A systematic review was carried out to summarize the current level of evidence for the treatment of LDS. Clinical scenarios were generated comprising combinations of signs and symptoms in LDS and other relevant variables. Based on the systematic review and their own clinical experience, twelve multidisciplinary international experts rated each scenario on a 9-point scale (1 highly inappropriate, 9 highly appropriate) with respect to performing decompression only, fusion, and instrumented fusion. Surgery for each theoretical scenario was classified as appropriate, inappropriate, or uncertain based on the median ratings and disagreement in the ratings.
RESULTS: 744 hypothetical scenarios were generated; overall, surgery (of some type) was rated appropriate in 27 %, uncertain in 41 % and inappropriate in 31 %. Frank panel disagreement was low (7 % scenarios). Face validity was shown by the logical relationship between each variable's subcategories and the appropriateness ratings, e.g., no/mild disability had a mean appropriateness rating of 2.3 ± 1.5, whereas the rating for moderate disability was 5.0 ± 1.6 and for severe disability, 6.6 ± 1.6. Similarly, the average rating for no/minimal neurological abnormality was 2.3 ± 1.5, increasing to 4.3 ± 2.4 for moderate and 5.9 ± 1.7 for severe abnormality. The three variables most likely (p < 0.0001) to be components of scenarios rated "appropriate" were: severe disability, no yellow flags, and severe neurological deficit.
CONCLUSION: This is the first study to report criteria for determining candidacy for surgery in LDS developed by a multidisciplinary international panel using a validated method (RAM). The panel ratings followed logical clinical rationale, indicating good face validity. The work refines clinical classification and the phenotype of degenerative spondylolisthesis. The predictive validity of the criteria should be evaluated prospectively to examine whether patients treated "appropriately" have better clinical outcomes.
Mots-clé
Decompression, Surgical/standards, Lumbar Vertebrae/surgery, Patient Selection, Spinal Fusion/standards, Spondylolisthesis/classification, Spondylolisthesis/surgery
Pubmed
Web of science
Création de la notice
02/10/2014 17:27
Dernière modification de la notice
20/08/2019 14:28
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