Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P75. Does the concomitant presence of scoliosis or spondylolisthesis affect outcomes following stability-preserving lumbar decompression for spinal stenosis?

Abstract

BACKGROUND CONTEXT Lumbar stenosis can be accompanied by degenerative scoliosis and spondylolisthesis, which complicates neural compression and makes deciding on a surgical treatment more complex. Once conservative measures fail, procedures can include: decompression alone, decompression with limited spinal fusion (or fusion at just the spondylolisthesis level), or long spinal fusion to regain acceptable alignment. The concern of an open decompression-only surgery in patients with lumbar stenosis and concurrent scoliosis and/or spondylolisthesis has been described in literature, given the risk of destabilizing the spine and precipitate deformity progression. PURPOSE The purpose of this study was to compare the patient outcomes between lumbar decompression alone for patients with lumbar stenosis alone and those with stenosis and a concomitant scoliosis and/or spondylolisthesis. STUDY DESIGN/SETTING Retrospective cohort series. PATIENT SAMPLE We performed a retrospective analysis of patients who underwent a primary lumbar laminectomy between 2009 and 2015 by one of two senior orthopedic spine surgeons. Patients were excluded from analysis if they had any previous lumbar surgery), were under 18years of age at the time of surgery, or had postoperative follow up less than 3 months. Patients were divided into three groups: those diagnosed with lumbar stenosis alone (without concomitant scoliosis or spondylolisthesis), those with a concomitant scoliosis (>10° of coronal angulation), and those with stenosis and a concomitant spondylolisthesis at the level of decompression). OUTCOME MEASURES Lumbar plain radiographs were evaluated to assess for concomitant scoliosis and spondylolisthesis diagnoses. Patient reported outcomes were obtained in the form of Oswestry Disability Index (ODI) scores, Visual Analog Scales (VAS) scores for the back and leg, 12-Item Short Form Mental and Physical Survey (SF-12) scores, and the Veterans Rand 12-Item Health Mental and Physical Survey (VR-12) scores. METHODS Baseline patient characteristics were compared using chi-squared analysis and independent sample t-tests for categorical and continuous data, respectively. Bivariate and multivariate regressions were subsequently used to compare clinical outcomes between procedure groups. Multivariate analyses controlled for differences in baseline patient characteristics. RESULTS Overall, 212 consecutive patients who fulfilled our inclusion criteria were assessed. All patients with a spondylolisthesis were found to be Meyerding Grade 1 and stable on flexion or extension lumbar plain radiographs. The patients in the scoliosis group were found to have significantly more patients with an American Society of Anesthesiologists (ASA) grade of 3 or greater (48.8% vs. 32.2%; p=.001) compared to the stenosis-only patients. A herniated disc was present more often in the stenosis-only and stenosis group compared to the patients presenting with spondylolisthesis (p CONCLUSIONS At approximately two years after lumbar decompression alone, the presence of concomitant scoliosis or stable spondylolisthesis in lumbar spinal stenosis patients do not appear to impact clinical outcomes. Overall re-operation rates are low and similar between the three groups. Patients who present with scoliosis or a stable spondylolisthesis can expect similar improvement of symptoms, following a stability-preserving lumbar decompression, as those who present with stenosis-alone.