Abstract # 37553 Rates of Complications and Required Additional Surgical Interventions after Surgical and Nonsurgical Treatment in Lumbar Spondylosis: A Systematic Review with Meta Analysis Andriy Noshchenko PhD, Emily M. Lindley PhD, Evalina L. Burger MD, Christopher M.J. Cain MD, Vikas V. Patel MD

The purpose of this study Evaluate and compare: 1. long term complication rate; 2. rate of additional surgical treatment; after surgical and nonsurgical treatment in lumbar spondylosis Surgical treatment included: arthrodesis, decompression without arthrodesis arthroplasty

Methods Comprehensive literature search: MEDLINE, EMBASE and the Cochrane Library Selection of publications (randomized controlled clinical trials) Quality assessment of included studies (Cochrane Back Review Group scale) Data extraction (complication and additional surgical treatment rates) Meta analysis of the combined data (inverse variance method, random effect modeling) Level of evidence assessment (GRADE)

Results: Literature search Of 1411 total citations, 26 RCTs of 4949 participants were included in the review and meta analysis [1-26] Selected studies had moderate quality, with scores ranging from 6-9 (out of 12) on the Cochrane Back Review Group scale

Results: Pooled outcomes

Results: Comparative meta analysis FAVORABLE FOR COMPARED TREATMENT FAVORABLE FOR LUMBAR FUSION

Conclusions/Level of evidence Level of evidence (GRADE) Conclusions High Lumbar arthrodesis was associated with higher complication rate than lumbar arthroplasty at 2 years postoperative due to pseudarthrosis, autograft donor site pain, and loss of disc height typical for this intervention Moderate However, the rate of additional surgery was not significantly different between lumbar arthrodesis, lumbar arthroplasty, and decompression without fusion The rate of surgical treatment 2-4 years after conservative treatment was significantly higher then that after lumbar arthrodesis

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