CHICAGO — An appropriate use criteria study presented at the North American Spine Society Annual Meeting showed decompression without fusion was inappropriate for most cases of degenerative scoliosis and stenosis.
Using the RAND/UCLA Appropriateness Method, Michael D. Daubs, MD, and colleagues developed 260 scenarios based on seven different clinical characteristics of patients with degenerative scoliosis and stenosis. A panel of neurosurgeons, orthopedic spine surgeons, physiatrists, a researcher/physical therapist and a geriatrician discussed the risks and benefits and rated the appropriateness of the following five treatments for each scenario: decompression alone; fusion alone; decompression and fusion; fusion and deformity correction; and decompression, fusion and deformity correction, according to Daubs.
In a review that included patient symptoms, radiographic findings, degree of patient curve, deformity and sagittal imbalance, Daubs noted most scenarios were inappropriate for surgery, especially among patients without significant symptoms.
“Most of the scenarios we looked at were inappropriate for surgery overall, and only appropriate for about 13% of all the different combined scenarios of procedures,” Daubs said in his presentation here.
He added 80% of the scenarios reviewed were inappropriate for decompression. However, Daubs noted decompression was appropriate in patients with curves less than 30°.
“Decompression without fusion was found to be appropriate for patients who had two levels or lower levels of decompression, laminectomies, curve magnitude less than 30° and patients who did not have sagittal imbalance — that was the big key,” Daubs said. – by Casey Tingle
Daubs MD, et al. Abstract 261. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2019; Chicago.
Disclosure: Daubs reports he is a board or committee member for AOSpine North America, Cervical Spine Research Society and lumbar spine research society; receives IP royalties from DePuy; receives research support from Pfizer; and is on the editorial or governing board for The Spine Journal.