New study will evaluate spinal fusion surgeries

Dr. Chris Bailey is working to determine the best surgical technique for patients with lumbar degenerative spondylolisthesis. A debilitating spinal defect, spondylolisthesis is the most common reason for spinal surgery in older adults. While spinal fusion is the surgery used to treat spondylolisthesis, there are two popular surgical techniques that differ in associated benefits, risks and costs.

Spondylolisthesis occurs when one vertebra, a bone in the spinal column, slips forward over another vertebra, causing back and leg pain. Spinal fusion is used to treat this condition by fusing together two vertebrae to stabilize and strengthen the spine while reducing pain.

Two popular techniques exist for treating spondylolisthesis. The first is called posterolateral fusion which uses screws, rods and a bone graft to essentially create a bridge between the two vertebrae. The second is called posterior interbody fusion which, in addition to using the screws, rods and bone graft, involves removing a disc between the affected vertebrae and replacing it with an artificial implant called an interbody device.

While there are theoretical benefits to adding the interbody device, there is no evidence that it results in better outcomes for all spondylolisthesis patients.

“There are certain clinical factors which indicate when an interbody device is beneficial,” said Dr. Chris Bailey, a Scientist at Lawson Health Research Institute and Orthopaedic Spine Surgeon at London Health Sciences Centre (LHSC). “However, many surgeons are using the interbody device in the broader patient population, even when those specific indications are not present.”

The interbody technique increases the length of the surgery and can also increase recovery time. This makes the surgery more risky for patients and more costly to the health care system. For these reasons, surgeons differ on which technique should be used.

To address this issue, Dr. Bailey and his colleagues are conducting a clinical trial that will compare the two procedures, including patient outcomes and cost to the health system. “With an aging population and growing concerns over the cost and rates of spinal fusions, we need to compile evidence to identify which technique provides optimal patient outcomes while saving costs to the health system,” said Dr. Bailey.

This research study will recruit participants over the course of two years. Patients who take part in the study will be randomized to receive either the posterolateral or interbody fusion surgery. Patient outcomes, including pain, function, quality of life and bone healing, will be measured while they are in-hospital and at 6 weeks, 3 months, 6 months and 12 months after surgery.

“We expect that posterolateral fusion will provide the same improvements in patient outcomes as interbody fusion, but that interbody fusion will be more expensive,” said Dr. Bailey. “If so, this will indicate that posterolateral fusion is a more cost-effective for both patients and the Canadian health care system.”

This research study is being funded through Lawson’s Internal Research Fund (IRF), designed to allow scientists and students the opportunity to obtain start-up funds for new projects with exciting potential. Dr. Bailey hopes to use the results of this pilot study to facilitate a national, multi-centre clinical trial.

“I see an opportunity to improve treatment using evidence-based surgical approaches,” said Dr. Bailey. “I believe that, in Canada, we can change the practice of surgeons frequently utilizing the interbody device by proving that it does not result in better outcomes for the wider patient population.”