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| ID | Type | Description | Link |
|---|---|---|---|
| 574896382 | Other Grant/Funding Number | Deutsche Forschungsgemeinschaft (DFG) |
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The goal of this clinical trial is to learn whether microdecompression alone is as effective as decompression with extension of fusion surgery in patients with symptomatic adjacent segment stenosis after previous lumbar fusion surgery.
The main questions it aims to answer are:
Is microdecompression alone non-inferior to decompression with extension of fusion in improving disability 24 months after surgery, as measured by the Oswestry Disability Index (ODI)? Does microdecompression alone result in similar or lower rates of complications, reoperations, pain, and radiological progression compared with decompression and fusion?
Researchers will compare microdecompression alone to decompression with extension of lumbar fusion to determine whether the less invasive procedure can achieve similar clinical outcomes while reducing surgical burden and preserving spinal structures.
Participants will:
Be randomly assigned to one of two treatment groups: microdecompression alone or decompression with extension of lumbar fusion.
Undergo the assigned surgical treatment. Attend clinical and radiological follow-up visits at 6, 12, and 24 months after surgery.
Complete questionnaires assessing disability, pain, quality of life, sleep quality, and mental health.
Undergo routine imaging and clinical examinations to evaluate treatment outcomes and possible complications.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Control | Active Comparator | Decompression and fusion |
|
| Intervention | Active Comparator | Mircosurgical decompression only |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Microsurgical Decompression with Extension of Fusion | Procedure | Participants undergo microsurgical decompression of symptomatic adjacent segment stenosis combined with extension of the existing lumbar fusion. |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of Participants Achieving at Least 30% Reduction in Oswestry Disability Index (ODI) | The primary endpoint is the proportion of participants achieving a reduction of at least 30% in the Oswestry Disability Index (ODI) compared with baseline. The ODI is a validated patient-reported outcome measure assessing disability related to lumbar spine disorders on a scale from 0% to 100%. A reduction of at least 30% is considered clinically meaningful. | 24 months after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Pain related disability | Disability related to low back pain assessed using the Oswestry Disability Index (ODI). The ODI score ranges from 0 to 100%, with higher scores indicating greater disability and worse functional impairment. | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Anton Früh, PD MD M.Sc. | Contact | +49 030 450 660 376 | anton.frueh@charite.de |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Charité - Universitätsmedizin Berlin | Berlin | State of Berlin | 10117 | Germany |
Individual participant data underlying the results reported in publications arising from this study, after de-identification, will be made available upon reasonable request to the corresponding investigator.
Supporting documents including the study protocol, statistical analysis plan, and data dictionary will also be made available.
Beginning 12 months following publication of the primary study results and ending 5 years after publication.
De-identified individual participant data (IPD) underlying the results reported in publications arising from this study, as well as the study protocol, statistical analysis plan, and analytic code, will be made available to qualified researchers.
Access will be granted to investigators who provide a scientifically sound research proposal that is approved by the study steering committee. Requests must be submitted to the study sponsor and should specify the intended use of the data.
Data will be shared only after publication of the primary study results and following execution of an appropriate data-sharing agreement. Access will be provided through a secure electronic data transfer system in accordance with applicable data protection regulations.
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| ID | Term |
|---|---|
| D013130 | Spinal Stenosis |
| ID | Term |
|---|---|
| D013122 | Spinal Diseases |
| D001847 | Bone Diseases |
| D009140 | Musculoskeletal Diseases |
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| Microsurgical Decompression Alone | Procedure | Participants undergo microsurgical decompression of symptomatic adjacent segment stenosis after previous lumbar fusion surgery without extension of the existing fusion. |
|
| Leg Pain Intensity at Rest |
Pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) for leg pain at rest.The NRS ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity. |
| Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Leg Pain Intensity during Movement | Pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) for leg pain during movement.The NRS ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity. | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Back Pain Intensity at Rest | Pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) for back pain at rest.The NRS ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity. | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Back Pain Intensity during Movement | Pain intensity assessed using the Numeric Rating Scale (NRS; 0-10) for back pain during movement.The NRS ranges from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity. | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Maximum Walking Distance | Maximum walking distance measured in meters. | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Health-Related Quality of Life Assessed by the 36-Item Short Form Health Survey (SF-36) | generates eight domain scores (physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), each transformed to a scale ranging from 0 to 100, with higher scores indicating better health-related quality of life and functional status. Unit of Measure: Points on a scale (0-100). | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Health-Related Quality of Life Assessed by the EuroQol 5-Dimension 5-Level Questionnaire (EQ-5D-5L) Index Score | Health-related quality of life assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L). The EQ-5D-5L evaluates five dimensions of health status (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), each with five response levels. Responses are converted into a single EQ-5D-5L Index Score using an established country-specific value set. Higher index scores indicate better health-related quality of life. Unit of Measure: Utility index score (higher scores indicate better health-related quality of life). | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Mood Assessed by the German General Depression Scale - Short Form (ADS-K) | Depressive symptoms assessed using the German General Depression Scale - Short Form (ADS-K). The ADS-K is a self-report questionnaire comprising 15 items, each rated on a 4-point Likert scale (0-3 points). Total scores range from 0 to 45 points, with higher scores indicating more severe depressive symptomatology and worse mood status. Unit of Measure: Points on a scale (range: 0-45; higher scores indicate more severe depressive symptoms) | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Sleep Quality Assessed by the Pittsburgh Sleep Quality Index (PSQI) | Sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI). The PSQI is a self-administered questionnaire evaluating sleep quality and disturbances over the previous month across seven domains: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Component scores are summed to generate a global PSQI score ranging from 0 to 21 points, with higher scores indicating poorer sleep quality and greater sleep disturbance. Unit of Measure: Points on a scale (range: 0-21; higher scores indicate worse sleep quality). | Baseline (before surgery), 6 months after surgery, 12 months after surgery, and 24 months after surgery. |
| Length of hospital stay | Length of hospital stay measured in days from surgery until hospital discharge. | From date of surgery until hospital discharge, up to 30 days postoperatively |
| Intensive Care Unit Stay | Duration of intensive care unit stay measured in days. | From admission to the intensive care unit after surgery until discharge from the intensive care unit, up to 30 days postoperatively. |
| Additional or Revision Spine Surgery | Proportion of participants requiring additional spinal surgery or revision surgery during follow-up. | Up to 24 months after surgery |
| Perioperative Complications | Number and type of perioperative complications associated with the surgical procedure. | Perioperative/Periprocedural |
| Operative Parameters | Operative duration, intraoperative blood loss | Perioperative/Periprocedural |
| Dynamic Spondylolisthesis | Presence of dynamic spondylolisthesis defined as a translation of ≥3 mm on flexion-extension radiographs.Unit of Measure: Participants with dynamic spondylolisthesis. | 24 month after surgery |
| Central Stenosis Severity Assessed by the Schizas Classification | Central canal stenosis at the adjacent segment assessed on MRI using the Schizas classification (Grades A-D).Unit of Measure: Grade (A-D; higher grades indicate more severe stenosis). | 24 months after surgery |
| Foraminal Stenosis Severity Assessed by the Lee Classification | Foraminal stenosis at the adjacent segment assessed on MRI using the Lee classification (Grades 1-4).Unit of Measure: Grade (1-4; higher grades indicate more severe foraminal stenosis). | 24 months after surgery. |
| Implant Integrity | Implant integrity assessed on radiographs, including evidence of implant loosening, breakage, or material dislocation.Unit of Measure: Participants with implant failure. | 24 months after surgery. |
| Segmental Lordosis | Segmental lordosis measured on standing lateral radiographs.Unit of Measure: Degrees (°). | 24 months after surgery. |