The 2022 Thomas E. Whitecloud Award for best clinical research paper was recently presented by the Scoliosis Research Society for a head to head, level one comparison study of instrumented vs uninstrumented spondy.
Best Research Paper Award Goes to … Spondy Study!!
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#spondylolisthesis#scoliosisresearch#thomaswhitecloudaward
The authors of the study, “Randomized Controlled Trial of Instrumented vs. Uninstrumented Posterolateral Fusion for Lumbar Spondylolisthesis” Andreas K. Andresen, M.D., Leah Y. Carreon, M.D., M.S.; and Mikkel Østerheden Andersen, M.D. received this excellent award at the 29th International Meeting on Advanced Spine Techniques (IMAST).
The award, named after IMAST co-founder Dr. Thomas E. Whitecloud, is presented to the best basic science/translational and best clinical papers.
Dr. Andresen, co-author and currently a Ph.D. candidate at the University of Southern Denmark, explained the genesis of the study to OTW, “Our standard of treatment for degenerative spondylolisthesis in the elderly, 60 years and above, has been uninstrumented fusion, due to a perceived risk of early complications due to screw pullout and fusion failure in patients with poor bone stock.”
“Over the last eight years, two randomized trials have been performed in our institution, investigating different methods to provide fusion when doing uninstrumented fusion. When doing these trials, we noticed a fusion rate close to 30% in the control groups. With the addition of a professor from Louisville to our department, the idea to investigate the outcome, fusion rates, and complications of adding instrumentation to the fusion was put into motion.”
Regarding the study design and implementation, Dr. Andresen noted, “The design was randomized, with blinding of statistician and investigator. This was chosen because the surgeons in our department wanted to inform the patients whether they had instrumentation or not, due to this being a new treatment in the elderly for us.”
“In our opinion, when fusion is deemed needed to treat degenerative spondylolisthesis, it is safe to do instrumented fusion at one-level, even into old age. Our mean age in the study was 71.5 years, and 85% were women, and we had no reoperations due to screw pullout, or adjacent level disease within the two-year study period.”
“For us, this has changed the treatment of degenerative spondylolisthesis, from uninstrumented fusion to instrumented fusion. We will of course have to investigate the longer-term outcome to evaluate the durability of the two types of fusion.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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