Surgery For Degenerative Spondylolisthesis Research Articles

Severe Preoperative Disability Is Associated With Greater Mental Health Improvements Following Surgery for Degenerative Spondylolisthesis: A Cohort Matched Analysis.

To evaluate preoperative disability's influence on patient-reported outcomes (PROs) following surgery for degenerative spondylolisthesis (DS). DS patients who underwent surgical intervention were retrospectively identified from a single-surgeon spine registry. Cohorts based on Oswestry Disability Index (ODI) < 41 (milder disability) and ≥ 41 (severe disability) were created. Demographic differences were accounted for with 1:1 propensity score matching. For the matched sample, perioperative and PRO data were additionally collected. PROs assessed included mental health, physical function, pain, and disability. Pre- and up to 2-year postoperative PROs were utilized. Average time to final follow-up was 15.7 ± 8.8 months. Improvements in PROs and minimal clinically important difference (MCID) rates were calculated. Continuous variables were compared through Student t-test and categorical variables were compared through chi-square tests. Altogether, 214 patients were included with 77 in the milder disability group. The severe disability group had worse postoperative day (POD) 1 pain scores and longer hospital stays (p ≤ 0.038, both). The severe disability group reported worse outcomes pre- and postoperatively (p < 0.011, all), but had greater average improvement in 12-item Short Form health survey mental composite score (SF-12 MCS), 9-Item Patient Health Questionnaire (PHQ-9), visual analogue scale (VAS)-back, and ODI by 6 weeks (p ≤ 0.037, all) and PHQ-9, VAS-back and ODI by final follow-up (p ≤ 0.015, all). The severe disability cohort was more likely to achieve MCID for SF-12 MCS, PHQ-9, and ODI (p ≤ 0.003, all). Patients with greater baseline disability report higher POD 1 pain and discharge later than patients with milder disability. While these patients report inferior physical/mental health before and after surgery, they report greater improvements in mental health and disability postoperatively.

Patient reported outcomes following surgery for degenerative spondylolisthesis: comparison of a universal and multi-tier health care system

STUDY DESIGNRetrospective review of results from a prospectively collected Canadian cohort in comparison to published literature. OBJECTIVES(1) To investigate whether patients in a universal health care system have different outcomes than those in a multitier health care system in surgical management of degenerative spondylolisthesis (DS).(2) To identify independent factors predictive of outcome in surgical DS patients. SUMMARY OF BACKGROUND DATACanada has a national health insurance program with unique properties. It is a single-payer system, coverage is universal, and access to specialist care requires referral by the primary care physician. The United States on the other hand is a multitier public/private payer system with more rapid access for insured patients to specialist care. METHODSSurgical DS patients treated between 2013 and 2016 in Canada were identified through the Canadian Spine Outcome Research Network (CSORN) database, a national registry that prospectively enrolls consecutive patients with spinal pathology from 16 tertiary care academic hospitals. This population was compared with the surgical DS arm of patients treated in the Spine Patients Outcome Research Trial (SPORT) study. We compared baseline demographics, spine-related, and health-related quality of life (HRQOL) outcomes at 3 months and 1 year. Multivariate analysis was used to identify factors predictive of outcome in surgical DS patients. RESULTSThe CSORN cohort of 213 patients was compared with the SPORT cohort of 248 patients. Patients in the CSORN cohort were younger (mean age 60.1 vs. 65.2; p<.001), comprised fewer females (60.1% vs. 67.7%; p=.09), and had a higher proportion of smokers (23.3% vs. 8.9%; p<.001). The SPORT cohort had more patients receiving compensation (14.6% vs. 7.7%; p<.001). The CSORN cohort consisted of patients with slightly greater baseline disability (Oswestry disability index scores: 47.7 vs. 44.0; p=.008) and had more patients with symptom duration of greater than 6 months (93.7% vs. 62.1%; p<.001). The CSORN cohort showed greater satisfaction with surgical results at 3 months (91.1% vs. 66.1% somewhat or very satisfied; p<.01) and 1 year (88.2% vs. 71.0%, p<.01). Improvements in back and leg pain were similar comparing the two cohorts. On multivariate analysis, duration of symptoms, treatment group (CSORN vs. SPORT) or insurance type (public/Medicare/Medicaid vs. Private/Employer) predicted higher level of postoperative satisfaction. Baseline depression was also associated with worse Oswestry disability index at 1-year postoperative follow-up in both cohorts. CONCLUSIONSSurgical DS patients treated in Canada (CSORN cohort) reported higher levels of satisfaction than those treated in the United States (SPORT cohort) despite similar to slightly worse baseline HRQOL measures. Symptom duration and insurance type appeared to impact satisfaction levels. Improvements in other patient-reported health-related quality of life measures were similar between the cohorts.

P88. Non-fusion surgery for degenerative spondylolisthesis using artificial ligament stabilization: surgical indication and clinical results

P88. Non-fusion surgery for degenerative spondylolisthesis using artificial ligament stabilization: surgical indication and clinical results

4:48 Degenerative lumbar spondylolisthesis: a retrospective outcomes study comparing noninstrumented and instrumented fusion with preoperative disc height

Purpose of study: The surgical management of lumbar degenerative spondylolisthesis (DLS) often includes decompression and fusion. The addition of transpedicular instrumentation to improve upon fusion rate and outcome remains controversial. Some advocate the use of instrumentation when excessive segmental motion or translation is present. In the absence of radiographic motion, or “stable” spondylolisthesis, the use of fixation becomes less clear. The purpose of this study is to assess the impact of preoperative disc height on the outcome of surgery for DLS with and without instrumentation.Methods used: The outcomes of 65 patients with DLS treated with surgery were retrospectively reviewed. Thirty patients (24 women, 6 men; 59.3±10.4 years of age) underwent transpedicular instrumented posterolateral fusion (INST). Thirty-five patients (22 women, 13 men; 68.6±7.0 years of age) underwent in situ posterolateral fusion (ISF). Average follow-up was 36.7 months. Clinical evaluation at long-term follow-up included chart reviews and telephone questionnaires including back and leg pain visual analog scale (VAS), functional assessment and overall patient satisfaction. Radiographic analysis included preoperative measurements of central disc height. Analysis included all patients treated with or without fixation and subgrouped by preoperative disc height less than or equal to 8 mm or greater than 8 mm (Table 1)Table 1Degenerative spondylolisthesis outcomesDisc height (mm)Back pain*Leg painSittingLiftingWalkingActivitySatisfactionRepeat surgical decisionIn situ fusion (all)8.32 ± 3.81.89 ± 1.22.5 ± 1.41.93 ± 1.22.89 ± 1.673.17 ± 1.12.03 ± 0.731.38 ± 0.861.38 ± 1.08>9 mm11.05 ± 2.52.07 ± 1.492.67 ± 1.441.87 ± 1.362.87 ± 1.883.27 ± 1.092.13 ± 0.631.4 ± 0.911.53 ± 1.41<8 mm5.20 ± 2.11.88 ± 1.32.5 ± 1.451.87 ± 1.083.19 ± 1.63.19 ± 1.22.0 ± 0.631.50 ± 1.031.43 ± 1.09Instrumented fusion (all)7.62 ± 3.541.72 ± 1.072.39 ± 1.52.65 ± 1.563.78 ± 1.563.04 ± 1.232.08 ± 0.831.50 ± 0.831.65 ± 1.33>9 mm10.58 ± 1.671.78 ± 0.972.56 ± 1.741.89 ± 1.363.78 ± 1.093.0 ± 1.242.0 ± 0.821.5 ± 0.972.1 ± 1.79<8 mm5.26 ± 2.61.69 ± 1.22.28 ± 1.43.14 ± 1.53.78 ± 1.82.93 ± 1.32.06 ± 0.881.47 ± 0.741.28 ± 0.72*Back pain scale: 1 = improved, 5 = worse.. No patient had evidence of dynamic translation or significant angulation on initial radiographs. DLS was treated at L4–L5 in 83%, L3–L4 in 12% and L5–S1 in 4%.of findings: The findings are summarized in Table 1. VAS and functional assessments are based on a 1 to 5 scale (1 = improved, 5 = worsened).Relationship between findings and existing knowledge: The literature is replete with various studies assessing the role of instrumentation in lumbar degenerative conditions. The current study is in agreement with numerous studies suggesting that instrumentation may not be especially beneficial in terms of functional outcome in “stable” degenerative spondylolisthesis.Overall significance of findings: The results suggest no significant advantage in the use of instrumentation in DLS in the absence of significant radiographic motion regardless of preoperative disc height, although there was a trend toward less back pain with fixation.Disclosures: Device of drug: pedicle screw instrumentation. Status: approved.Conflict of interest: Louis Jenis, grant research support.