279 Does Surgical Treatment of Lumbar Spondylolisthesis Impact Self-care and Functional Independence? Five-Year Analysis of the Quality Outcomes Database

Abstract

INTRODUCTION: Lumbar spondylolisthesis may have an impact on patients’ ability to care for oneself and maintain functional independence. Surgical treatment is associated with improvement in patient function but the impact on self-care is not well understood. METHODS: This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade I lumbar spondylolisthesis with five years of follow-up were included. Patient reported outcomes (PROs) were recorded. Patients were grouped into baseline dependent or independent cohorts based on the Personal Care component of the ODI (0-2=independent; ³3=dependent). Minimum clinically important difference (MCID) was defined as a 30% reduction from baseline disability. RESULTS: Of the 602 patients, 535 (89%) were independent and 67 (11%) were dependent at baseline with mean age of 63 and 59, respectively (p = 0.01). 479 patients (80%) reported 60-month follow up Personal Care scores, with 59% reporting improvement and 41% having worse or no improvement. At 60-month follow-up, 87.5% of dependent patients had gained lasting independence. Dependent and independent cohorts met 5-year MCIDs at similar rates. Baseline dependence was universally associated with worse pre-operative PROs (p < 0.01). 60-month improvement in personal care was associated with greater satisfaction and rates of MCID for all PROs (p < 0.01). 60-month improvement in personal care was positively associated with surgical treatment including arthrodesis versus motion-preserving surgery (OR = 1.17, 95%CI 1.04-1.32, p = 0.01). CONCLUSIONS: Dependent patients with lumbar spondylolisthesis achieve very high rates of independence (87.5%) which is durable through 5 years of follow-up. The dependent cohort represented only 11% of the cohort and was significantly younger at baseline. Spondylolisthesis patients treated with arthrodesis are more likely to improve their long-term self-care and independence.