Patient-reported outcome of lumbar decompression with instrumented fusion for low-grade spondylolisthesis: influence of pathology and baseline symptoms.

Abstract

Low-grade isthmic and degenerative spondylolisthesis (DS) of the lumbar spine are distinct pathologies but both can be treated with lumbar decompression with fusion. In a very large cohort, we compared patient-reported outcome in relation to the pathology and chief complaint at baseline. This was a retrospective analysis using the EUROSPINE Spine Tango Registry. We included 582 patients (age 60 ± 15years; 65% female), divided into four groups based on two variables: type of spondylolisthesis and chief pain complaint (leg pain (LP) versus back pain). Patients completed the COMI preoperatively and up to 5years follow-up (FU), and rated global treatment outcome (GTO). Regression models were used to predict COMI-scores at FU. Pain scores and satisfaction ratings were analysed. All patients experienced pronounced reductions in COMI scores. Relative to the other groups, the DS-LP group showed between 5%and 11% greater COMI score reduction (p < 0.01 up to 2years'FU). This group also performed best with respect to pain outcomes and satisfaction. Long-term GTO was 93% at the 5year FU, compared with between 82% and 86% in the other groups. Regardless of the type of spondylolisthesis, all groups experienced an improvement in COMI score after surgery. Patients with DS and LP as their chief complaint appear to benefit more than other patients. These results are the first to show that the type of the spondylolisthesis and its chief complaint have an impact on surgical outcome. They will be informative for the consent process prior to surgery and can be used to build predictive models for individual outcome.