Wednesday, September 26, 2018 10:35 AM – 12:00 PM Understanding Lumbar Stenosis/Spondylolisthesis: 10. Comparing surgical outcomes between back pain dominant and leg pain dominant chief complaint for adult isthmic spondylolisthesis: a CSORN ambispective study

Abstract

BACKGROUND CONTEXT Fusion for isthmic spondylolisthesis is a commonly performed lumbosacral surgery. Patients will present with either a chief complaint that is back dominant pain or leg dominant pain. It is well recognized by spinal surgeons, that patients requiring lumbar surgery for a complaint that is predominantly leg pain, (radicular or neurogenic claudication) will have superior postoperative outcomes than those with a predominant complaint of low back pain. This has been well described for the common surgical indications of lumbar disc herniation requiring discectomy and lumbar spinal stenosis requiring laminectomy for example. However, unlike these lumbar pathologies, lytic spondylolisthesis is associated with mal-alignment secondary to inherent instability which may be a cause of low back pain that would be more amendable to surgical treatment using a fusion procedure. PURPOSE To compare patient-rated outcomes between the patients with a chief complaint of low back pain versus radicular pain who were treated with a posterior fusion for isthmic spondylolisthesis. STUDY DESIGN/SETTING Ambispective study from the Canadian Spine Outcome and Research Network (CSORN). PATIENT SAMPLE Patients were identified form the Canadian Spine Society registry who underwent a posterior fusion for isthmic spondylolisthesis between 2013 and 2016. CSORN prospectively enrolls patients with spinal pathologies requiring surgical treatment from 16 tertiary care academic hospitals across Canada. Inclusion criteria for this study included: 18 years of age or older, minimum of 1 year follow-up, surgeon-determined chief complaint of either back dominant or radicular pain, and completed preoperative and postoperative patient-rated outcome measures for leg pain and back pain. OUTCOME MEASURES Patient-rated outcome measures included the Numeric Pain Rating Scale (NPRS) for back pain and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Component Summary score (PCS) and Mental Component Summary score (MCS). METHODS Patients were classified into radicular pain (RP) or low back pain (LBP) groups according to their chief complaint which determined by the treating surgeon at the time of patient enrollment into the registry. Statistical analysis was performed on SPSS. Unpaired t-test, chi-square test or Fisher's exact test were used for comparison of patient characteristics and outcome scores between RP and LBP groups. Statistical significance was defined as P RESULTS A total of 136 patients were included according to the inclusion criteria. Seventy-six patients were female (56%). Eighty-seven (64%) patients had a chief complaint of RP and 49 (36%) patients had a chief complaint of LBP. There was no statistical significant difference in baseline demographics, except for mean BMI which was 28.9+/−6 for RP and 26.7+/−5.9 for LBP (p=.043). There was no statistical significant difference in preoperative back pain NPRS, ODI, PCS, or MCS between the two groups. The initial leg pain NPRS was significantly higher for the RP cohort (7.6+/−1.7) compared to the LBP cohort (5.9+/−2.6) (p=.00001).There was no difference in surgical parameters between groups. NPRS for leg and back pain, ODI, and PCS all significantly improved at 1-2 year follow-up. There was no difference between the RP and LBP cohorts in outcome measures. At 1-2 years following surgery, most patients were satisfied with treatment (85.9% RP vs. 88.5% LBP; p=.72). CONCLUSIONS The results of this study demonstrate that patients with a chief complaint of low back pain are expected to have similarly good outcomes as patients with a chief complaint of radicular pain following posterior spinal fusion for lytic spondylolisthesis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.