Progression to fusion after lumbar laminectomy for degenerative lumbar spondylolisthesis: Rate and risk-factors. A national database study

Abstract

ObjectiveLumbar laminectomy is often utilized in the treatment of degenerative lumbar spondylolisthesis. Risk factors that contribute to reoperation rates, in particular to progression to fusion, are poorly understood. We aimed to identify rate and risk factors of lumbar fusion surgery following lumbar laminectomy for the treatment of degenerative lumbar spinal spondylolisthesis. MethodsOur sample was obtained from the national MarketScan Commercial Claims and Encounters Database. We reviewed patients undergoing lumbar laminectomy for stable degenerative lumbar spondylolisthesis (Grade-1) at one or two levels between January 2007 and December 2016. ResultsA total of 33,681 patients were included. By 2 years after the index operation, 2.48 % of patients had required lumbar fusion surgery. Female sex was associated with lower odds (OR 0.8, 95 %CI 0.7–0.9) of reoperation for fusion. Diabetes (OR 1.2, 95 %CI 1.1–1.4), rheumatoid arthritis (OR 1.5, 95 %CI 1.2–1.7) and clinical presentation with LBP (OR 2.1, 95 %CI 1.6–2.9), lower extremity weakness (OR 1.4, 95 %CI 1.1–1.5), as well as occurrence of a postoperative neurological complications (OR 2.0, 95 %CI 1.1–3.4) increased the odds ratio for requiring fusion surgery within two years after lumbar laminectomy. ConclusionIn this large cross-sectional sample of a national claims database consisting of lumbar laminectomy patients for the treatment of spondylolisthesis, approximately 2.5 % required subsequent lumbar fusion. Several modifiable risk factors for fusion progression were identified, which may guide clinicians in shared decision-making and to help identify patients with elevated post-operative risk providing potential leverage point for prevention.