Summary
This study confirms the clinical impressions of the majority of spine surgeons. Patients with degenerative spondylolisthesis fare better with surgery compared to non-operative management. If this study results in an increase in the utilization of fusion surgery to treat spondylolisthesis, the device manufacturing companies, such as Medtronic, DePuy, Nuvasive, and others, may see increases in their sales. CMS may see a significant increase in the number of fusion surgeries performed as a result of this study. CMS may see less variability in the rates of fusion surgery around the country as a result of this study.
Analysis
Lumbar spinal fusion surgery for degenerative spondylolisthesis has been adopted by a large proprotion of spinal surgeons around the country to treat the symptoms of this painful condition.
Many studies in the recent past compared non-operative management versus decompression surgery alone, versus fusion surgery. Many of these studies have shown that fusion compared favorably to other methods of treatment. The study by Herkowitz et al is considered by most to be a landmark study considerig this issue.
Generally speaking, the older generation of spinal surgeons, especially among the neurosurgical population, is more reluctant to recommend fusion to the patient with lumbar spondylolisthesis. This reluctance is usually the result of training preferrences. The results of the SPORT may remove some of the variability among the surgeons in their treatment choices for this condition.
