208. Should patients with lumbar stenosis and Grade I spondylolisthesis be treated differently based on spinopelvic alignment? A comparison of clinical and patient reported outcomes within a single health system

Abstract

<h3>BACKGROUND CONTEXT</h3> Degenerative spondylolisthesis of the lumbar spine is one of the most common pathologies addressed by surgeons. Recently, high-level data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone. <h3>PURPOSE</h3> The present study is the first analysis to examine the effect of spinopelvic alignment on patient-reported outcomes following decompression alone versus decompression with fusion. <h3>STUDY DESIGN/SETTING</h3> Subgroup analysis of observational prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 679 patients with degenerative Grade I spondylolisthesis and stenosis treated with laminectomy alone or laminectomy with fusion at a tertiary care insitution. <h3>OUTCOME MEASURES</h3> Primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and postoperatively at 6 and 12 months. <h3>METHODS</h3> Patients underwent laminectomy alone or laminectomy with instrumented fusion for degenerative Grade I lumbar spondylolisthesis and stenosis. Four cohorts were created based on pelvic incidence minus lumbar lordosis (PILL): (1) fusion with PILL>10°, (2) fusion with PILL10°, and (4) decompression alone with PILL <10°. The between-group comparisons of PROMIS GPH/GMH score changes were analyzed using mixed-effects models. Analyses were conducted independently for the following: (1) unmatched cohort, (2) 1:1 propensity score matched patients (PSM), (3) coarsened exact matched (CEM) patients. <h3>RESULTS</h3> A total of 49.9% (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. When comparing low spinopelvic mismatch (PILL 10) patients, fusion-treated patients had improved postoperative PROs (GMH: 26.61 vs 20.75, p < 0.0001; GPH: 23.61 vs 18.13, p < 0.0001) at 10-12 months. Mixed effect modeling confirmed GPH score improvement was 5.11 (2.08 - 8.13) points higher at 10-12 months in the fusion group. <h3>CONCLUSIONS</h3> Among Grade I spondylolisthesis patients with PILL>10°, laminectomy with fusion was associated with greater improvement in physical health-related quality of life than laminectomy alone. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.