{"id":"4ab1e32e-3afe-4448-91bc-acc9ff5b3c63","slug":"a-review-reduced-reoperation-rate-for-multilevel-lumbar-laminectomies-with-noninstrumented-versus-instrumented-fusions","title":"A review: Reduced reoperation rate for multilevel lumbar laminectomies with noninstrumented versus instrumented fusions","authors":["Nancy Ellen Epstein"],"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.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/4ab1e32e-3afe-4448-91bc-acc9ff5b3c63/featured/hero-1782420810441.png","publishDate":"2016-05-17T00:00:00.000Z","doi":"10.4103/2152-7806.182546","categories":["Spine","Review Article"],"fullTextUrl":"http://surgicalneurologyint.com/wp-content/uploads/2016/05/6729/SNI-7-337.pdf"}