210. Patient-reported and clinical outcomes after lumbar laminectomy and fusion versus laminectomy alone in patients with lumbar spondylolisthesis and harmonious sagittal spinopelvic alignment

Abstract

<h3>BACKGROUND CONTEXT</h3> The treatment of degenerative spondylolisthesis with decompression alone remains controversial. However, it is well known that all degenerative spondylolistheses are not created equally. As such, one must compare equivalent pathology to better assess treatment options. <h3>PURPOSE</h3> This study assessed 2-year clinical outcomes following laminectomy plus fusion versus laminectomy alone for management of Grade I degenerative spondylolisthesis and comorbid spinal canal stenosis among patients with sagittal spinopelvic alignment (pelvic incidence - lumbar lordosis <10°). <h3>STUDY DESIGN/SETTING</h3> Subgroup analysis of observational prospective cohort study. <h3>PATIENT SAMPLE</h3> A total of 679 patients treated with laminectomy with fusion or laminectomy alone for Grade I degenerative spondylolisthesis and comorbid spinal stenosis at a tertiary care center. <h3>OUTCOME MEASURES</h3> Outcome measures comprised estimated blood loss, operative time, length of hospital stay, discharge to skilled nursing facility, prospective patient-reported outcomes (PROs) and reoperation. <h3>METHODS</h3> Cohorts were matched based on degree of lumbar spondylolisthesis, flexion-extension listhesis and intervertebral disc height. Two alternative matching methods were employed to minimize treatment selection bias when estimating treatment effects: (1) propensity score matching (PSM) and (2) coarsened exact matching (CEM). Binary outcomes between cohorts were evaluated using McNemar test; continuous outcomes used the Wilcoxon rank-sum test. <h3>RESULTS</h3> A total of 327 (48.1%) study patients had low PILL mismatches (< 10°), indicating good sagittal spinopelvic alignment. After PSM and CEM matching to control treatment choice bias, patients undergoing fusion experienced greater operative blood loss (203 vs 125 mL, p=0.0006), operative time (216 vs 128 min, p=0.0006), and length of stay (3.50 vs 2.83 days, p < 0.0001) than patients receiving decompression alone; in turn, these patients were more likely to be discharged to rehabilitation facilities (6.86% vs 0.98%, p=0.0412) and receive longer durations of physical therapy postoperatively (2.47 vs 1.34 months, p<0.0001). Finally, fusion-treated patients had a greater likelihood of reoperation at 2 years (25.49% vs 14.71%, p=0.0152). CEM matching generally did not alter the pattern, significance or direction of findings. <h3>CONCLUSIONS</h3> Lumbar laminectomy was superior to fusion in health-related quality of life and reoperation rate at 2 years postoperatively for patients without PILL mismatch. Patients with low-grade spondylolisthesis, spinal stenosis, and spinopelvic harmony may benefit from less invasive decompression alone. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.