Landmark Study Shows Lumbar Facet Arthroplasty Superior to Fusion for Spinal Stenosis and Spondylolisthesis

Tim Allen, June 26th, 2024, OrthoSpineNews –

A study published in the Journal of Bone and Joint Surgery has found that lumbar facet arthroplasty, a type of implant surgery, may offer significantly better outcomes than traditional spinal fusion for patients with a specific type of lower back pain.

The study, led by Dr. Ahmad Nassr from the Mayo Clinic, compared two surgical approaches for treating lumbar spinal stenosis (LSS) and Grade I degenerative spondylolisthesis (DS). LSS is a narrowing of the spinal canal that compresses nerves, causing pain, numbness, and weakness. DS is a condition where one vertebra slips slightly forward over another. Both conditions are most common in people over 50.

Traditional Fusion vs. Modern Arthroplasty

The traditional approach, spinal fusion, involves permanently joining vertebrae together to stabilize the spine and relieve pressure on nerves. The newer technique, lumbar facet arthroplasty, utilizes an implant to replace a damaged facet joint, aiming to achieve the same goals while preserving some natural spinal movement.

Study Design and Results

The randomized controlled trial enrolled 321 patients and assigned them to either arthroplasty or fusion surgery. The primary outcome measure was “composite clinical success” at 24 months, a combination of factors including pain reduction, function improvement, and patient satisfaction.

The results appeared positive for the arthroplasty group. Nearly three times as many patients (73.5%) in the arthroplasty group achieved composite clinical success compared to the fusion group (25.5%). Additionally, the arthroplasty group reported better scores on pain scales and disability questionnaires.

Reduced Complications and Preserved Motion

Importantly, the study also found that the fusion group experienced a higher rate of complications, including a condition called “adjacent segment degeneration” where the discs above or below the fused area deteriorate. This highlights a potential benefit of arthroplasty – preserving motion and potentially reducing stress on nearby spinal segments.

A New Hope for Patients

The findings of this study represent a potentially significant advancement in the treatment of LSS and DS. Spinal fusion has long been the standard surgical approach, but concerns about limited mobility and potential complications have persisted. Lumbar facet arthroplasty, as demonstrated by this study, offers a compelling alternative with the potential for superior patient outcomes and a reduced risk of complications.

Learn more about this study by visiting The Journal of Bone & Joint Surgery and Premia Spine.