BACKGROUND CONTEXT: @entity1 with @entity612 with concomitant @entity179 ( @entity179 ) and predominance of @entity615 have been shown to have inferior outcome after surgery. Studies comparing outcome according to @entity158 predominance and treatment received are lacking. PURPOSE: To study if adding spinal fusion to the decompression in @entity179 impacts outcome in @entity1 with @entity615 ( @entity615 VAS >=  @entity158 VAS) compared to predominant @entity158 ( @entity615 VAS < @entity158 VAS). @entity1 SAMPLE: The Swedish Spine Register was used and included 1,624 @entity1 operated for @entity179 at the L4-L5 level. OUTCOME MEASURES: Self-reported measures were used, including a visual analogue scale (VAS) for back and @entity158 , the Euroqol-5 (EQ-5D) and the physical and mental component summaries of the Short-form 36 to estimate health related quality of life (HRQoL) and the @entity717 index (ODI) to estimate function. METHODS: Inclusion criterion was single level @entity179 operated on with either decompression only (D) or decompression and instrumented posterolateral fusion (DF). Based on preoperative @entity615 scores, the @entity1 were assigned to one of two groups: @entity158 predominance. The @entity1 completed the outcome protocol at 1 and 2 year follow-up. Statistical analysis was performed using linear regression adjusting for multiple potential confounders. RESULTS: In the adjusted outcome at the 1 year follow-up, @entity1 with predominant @entity158 reported a 7.9 mm more improvement on the VAS for @entity615 with fusion, compared to decompression only (95%CI: 0.7-15.2), p=0.03. Despite more change in the fused group, the reported @entity615 levels remained similar in the decompressed only versus decompressed and fused at the 1 year follow-up (28 vs. 24, p=0.77). The @entity1 with @entity615 benefited from adding fusion in @entity615 7.1 (95%CI: 0.3-13.9, p=0.04), @entity158 8.8 (95%CI: 2-15.7, p=0.01), the ODI 5.7 (95%CI: 1.6-9.9, p=0.006) and the EQ-5D 0.09 (95%CI:1.7-0.02, p=0.02) at the 1 year follow-up as the DF group reported greater change in outcome compared to the D group. At the 2 year follow-up no significant differences were found between decompressed only and decompressed and fused in either the @entity615 predominant groups. CONCLUSION: @entity1 with @entity615 operated with DF report better outcomes in terms of @entity158 , function and HRQoL than @entity1 with only decompression. Although these differences are significant on a group level they may fail to reach minimal clinical significant difference. @entity1 with predominant @entity158 report significantly more improvement in @entity615 with DF compared to D but due to baseline differences in preoperative BP these improvements may not be explained by the added fusion per se. At the two year follow-up no significant differences were observed between the D and DF @entity1 in either the PB or PL groups but greater loss to follow-up in the DF groups could potentially bias these findings.

Outcome of decompression with and without fusion in XXXX with @entity179 in relation to @entity158 pattern - A register study of 1,624 @entity1 .

@entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'PATIENT'] @entity612 :: ('MESH:D013130', 'Disease') :: ['spinal stenosis'] @entity615 :: ('MESH:D001416', 'Disease') :: ['leg and back pain', 'leg or back pain', 'terms of back pain', 'back pain', 'predominant back pain'] @entity179 :: ('MESH:D019636', 'Disease') :: ['degenerative spondylolisthesis', 'DS'] @entity158 :: ('MESH:D010146', 'Disease') :: ['Leg pain predominance or back pain', 'pain', 'leg pain', 'preoperative pain'] @entity717 :: ('MESH:D009069', 'Disease') :: ['Oswestry disability']
@entity612 :: (MESH:D013130,Disease) :: ['spinal stenosis']
