Study Design: Retrospective study.
Objective: To examine whether the outcomes of decompression alone or decompression with fusion differed depending on the presence or absence of the facet effusion sign in degenerative spondylolisthesis.
Summary of Background Data: There is ongoing discussion as to whether fusion in addition to decompression (D&F) is superior to decompression alone (D) in the surgical treatment of patients with lumbar degenerative spondylolisthesis (LDS) and symptoms of spinal or radicular claudication. Previous studies have shown that a positive facet joint effusion sign on MRI correlates with the spontaneous reduction of slip when comparing upright and supine postures and might represent a sign of instability, guiding treatment decisions.
Patients and Methods: 160 patients (age 69 (SD10) y; 119 women, 41 men) with a diagnosis of LDS were identified retrospectively from our Spine Center Registry (linked to the SSE Spine Tango). They were categorised regarding the presence/absence of the facet effusion sign and the type of treatment received. 44 patients had effusion and underwent D; 76 effusion, and D&F; 19 no effusion, and D; and 21 no effusion, and D&F. Before surgery, and 3, 12 and 24 months after surgery, patients completed the multidimensional Core Outcome Measures Index (COMI) questionnaire. At follow-up, they rated the global treatment outcome (1-5 scale). Multiple regression analyses evaluated the factors influencing outcome.
Results: When age and gender was controlled for, there was no significant difference in outcome dependent on the presence of the facet effusion sign and/or the treatment received (D vs D&F).
Conclusions: Whilst mindful of the limitations of this retrospective study, we conclude that the effusion sign alone does not appear to be an indication for adding fusion to decompression in the treatment of LDS. Hence, the presence of the facet effusion sign should not, in itself, deter the surgeon from performing decompression alone. However, the phenomenon should be investigated in larger samples of patients, ideally within a randomised trial.
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