271. Surgical technique and patient-reported outcomes in adult isthmic spondylolisthesis

Abstract

BACKGROUND CONTEXT Combined anterior lumbar interbody fusion (ALIF) with posterior lumbar decompression and fusion (PLDF), and transforaminal lumbar interbody fusion (TLIF) are two procedures recommended to improve clinical outcomes in adult patients with isthmic spondylolisthesis. However, there is debate whether TLIF provides superior clinical outcomes to ALIF combined with PLDF, specifically regarding patient-reported outcome measures (PROMs). PURPOSE The purpose of this study was to compare PROMs between combined ALIF-PLDF and TLIF techniques following lumbar spinal fusion for adult isthmic spondylolisthesis. STUDY DESIGN/SETTING This study was a retrospective analysis of prospectively collected data from a single, high-volume academic medical center. PATIENT SAMPLE Patients who underwent lumbar fusion for isthmic spondylolisthesis from 2014 to 2019 were included in the analysis. Surgery was indicated after failure of conservative treatment to address radiculopathy and/or neurogenic claudication. OUTCOME MEASURES Patient-reported outcome measures were collected at preoperative and postoperative clinical visits. Metrics recorded include the visual analog scale for back pain (VAS back) and leg pain (VAS leg), the Short-Form 12 Mental Component Score (MCS-12) and Physical Component Score (PCS-12), and the Oswestry Disability Index (ODI). Secondary measures included estimated blood loss (EBL) and hospital length of stay (LOS). METHODS Patient and surgical characteristics including age, gender, body mass index (BMI), Charlson Comorbidity Index (CCI), number of levels decompressed and number of levels fused were recorded. Preoperative and final patient-reported outcome measures were obtained from an institutional query. For analysis, patients were divided into two groups based on surgical technique: combined anterior fusion with posterior stabilization (ALIF-PLDF) or anterior and posterior fusion through a posterior approach (TLIF). Multivariate linear regression was performed to correlate surgical approach and PROMs. RESULTS A total of 125 patients were included in final analysis, with 62 patients in the ALIF-PLDF group and 63 patients in the TLIF group. Patients undergoing ALIF-PLDF were more likely to be older (p=0.041) and have shorter LOS (p=0.009), while patients in the TLIF group had significantly more smoking history (p=0.007), more comorbid conditions (p=0.003), and higher number of levels decompressed (p=0.003). Patients in both the ALIF-PLDF group and the TLIF group had significant improvements in VAS back scores (p CONCLUSIONS Our results indicate that patients with isthmic spondylolisthesis treated with ALIF-PLDF approaches show significant improvements in all evaluated PROMs from initial preoperative visit to final follow-up, whereas similar patients treated with a TLIF approach have significant improvements in all PROMs except MCS-12. Our data further suggest that TLIF is more likely to be chosen for older, chronically ill patients, and those undergoing decompression at a higher number of levels. Despite these baseline differences, PROMs are similar between both fusion methods. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.