Surgery For Spondylolisthesis Research Articles

Machine Learning Models Leveraging Smartphone-Based Patient Mobility Data Can Accurately Predict Functional Outcomes After Spine Surgery

Objective: The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients’ functional recovery can improve timely intervention. In this study, we developed machine learning (ML) models to predict the occurrence of post-operative decline in patient mobility. Methods: Patients receiving spine surgery for degenerative spinal stenosis or spondylolisthesis were retroactively consented and enrolled. Activity data (steps-per-day) previously recorded across a 4-year peri-operative were collected alongside relevant clinical and demographic variables. Logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost) ML models were constructed and trained on 80% of the dataset and validated using the remaining 20%. The study’s primary endpoint was the models’ ability to predict post-operative decline in patient mobility. Results: A total of 75 patients were included. Following training, RF and XGBoost models achieved accuracy values of 86.7% (sensitivity 80%, specificity 90%) and 80% (sensitivity 60%, specificity 90%), respectively, in predicting post-operative functional decline. The LR model was the least effective with an accuracy of 73.3% (sensitivity 50%, specificity 88.8%). Receiver operating characteristic curves showed an area under the curve of 0.80 for RF, 0.70 for XGBoost, and 0.69 for LR. Conclusions: ML models trained on activity data collected from smartphones successfully forecast functional decline in post-operative activity following spine surgery. These results lay the groundwork for the future integration of ML into the surgeon’s toolbox for prognostication and surgical planning.

Experience of use of intraoperative computed tomography and navigation systems in minimally invasive surgery for lumbosacral spondylolisthesis

This article discusses the minimally invasive surgical technique for lumbosacral spondylolisthesis. The use of intraoperative computed tomography (iCT) and a navigation system significantly enhances the accuracy of screw placement and reduces the extent of soft tissue damage. From March 2018 to February 2024, 246 patients with lumbosacral spondylolisthesis underwent minimally invasive surgery with the use of iCT and navigation systems at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation. Of the above-mentioned cases, spondylolisthesis was most commonly observed at the L4-L5 (126 cases) and L5-S1 (98 cases) levels. This article presents two clinical cases from this series demonstrating successful use of these technologies.

P293. Surgeons’ selection of the right patient for fusion surgery for degenerative spondylolisthesis

P293. Surgeons’ selection of the right patient for fusion surgery for degenerative spondylolisthesis

Ruthenibacterium lactatiformans isolated from a human blood culture: a first report

BackgroundRuthenibacterium lactatiformans, a Gram-stain-negative, rod-shaped, obligate anaerobic bacterium of the Oscillospiraceae family, has not been previously reported in human infections. This study reports the first case of bacteraemia and potential vertebral osteomyelitis caused by Ruthenibacterium lactatiformans.Case presentationAn 82-year-old man with a history of diabetes, chronic renal failure, and prior spinal surgery for spondylolisthesis and spinal stenosis presented with fever and lower back pain. Magnetic resonance imaging revealed multiple vertebral osteomyelitis lesions. Initial blood cultures identified methicillin-resistant Staphylococcus aureus (MRSA), which prompted vancomycin treatment. However, repeated blood cultures not only confirmed persistent MRSA, but also detected Gram-negative bacilli (GNB). Despite surgical removal of the spinal hardware and antimicrobial therapy, the patient’s osteomyelitis worsened, necessitating transfer for further management. Subsequent analysis using 16S rRNA gene sequencing identified the GNB as Ruthenibacterium lactatiformans.ConclusionsThis is the first documented instance of human infection with Ruthenibacterium lactatiformans, signifying its pathogenic potential in vertebral osteomyelitis. The involvement of anaerobic bacteria and the possibility of polymicrobial infections complicate the diagnosis and treatment of vertebral osteomyelitis. This report underscores the need for caution when identifying the causative organism and selecting an appropriate treatment.

The Relationship Between MRI Findings of Posterior Ligamentous Complex and Lumbar Instability in Degenerative Spondylolisthesis.

To determine the factors in posterior ligamentous complex indicating lumbar instability in patients diagnosed with degenerative spondylolisthesis on conventional magnetic resonance imaging (MRI). We retrospectively analyzed patients who underwent PLIF surgery for degenerative spondylolisthesis at our institution between 2018 and 2020 and who had complete eligible preoperative imaging data for review and study, including lumbar MRI and anteroposterior and flexion-extension radiographs. Fifty-three patients were confirmed to have lumbar instability (Unstable Group, 44%), while sixty-seven patients (Stable Group, 56%) did not have instability on radiographs. The patients in the stable group had more advanced status of the degeneration of intervertebral disc than in the unstable group (p<0.05). The degeneration of supraspinous ligament (SSL) was more severe in the unstable group (p<0.05). Compared with the patients with rotatory instability, advanced degeneration of interspinous ligament (ISL) and SSL was observed in patients with translatory instability (p<0.05). However, there was no significant difference with regard to the height of the spinous process and the interspinous distance in patients with or without instability. This MRI analysis showed that abnormal segmental motion is closely associated with the pathological characteristics of supraspinal ligament. Advanced degeneration of SSL in patients with degenerative spondylolisthesis should raise the suspicion for lumbar instability and additional evaluations. The status of ISL and ligamentum flavum (LF) may not be helpful for the diagnosis of lumbar instability. Functional radiographs combined with MRI may provide valuable information when diagnosing lumbar instability in patients with mechanical back pain.

Epidemiology of Spondylolisthesis: A Nationwide Study From 2001 to 2016 in the Italian Population.

Epidemiological study. This study aimed to evaluate the annual incidence of spondylolisthesis requiring surgery in Italy and the epidemiological characteristics of the patients. The health care system continues to incur considerable costs as a result of low-back pain. Segmental instability of the lumbar spine has attracted significant interest from researchers as a potential mechanism leading to mechanical low back pain. The Italian Ministry of Health's National Hospital Discharge Reports database in the 2001-2016 period was considered. A total of 55,804 hospital admissions for spondylolisthesis were performed in Italy. The cumulative incidence was 6.8 interventions for every 100,000 Italian adult residents. The highest amount of procedures was recorded in the 65-69 years of age group. The overall patient's age was 56.8 ± 15.1 years. The 62.2% of patients were females. The average hospital stay length was 8.1 ± 7.3 days. On average, older patients require more days of hospital stay. Over the study period, it was observed a decreasing trend in the average number of days of hospital stay. The main primary diagnoses included were "acquired spondylolisthesis" [International Classification of Diseases (ICD) code: 738.4; 57.8%] and "spondylolisthesis" (ICD code: 756.12; 42.2%). By far, the main primary procedure performed was "lumbar and lumbosacral fusion of the anterior column, posterior technique" (ICD code: 81.08; 60.3%). Spondylolisthesis is a problem in Italy and a leading cause requiring spine surgery. Females were the majority of patients requiring surgery for spondylolisthesis. However, for younger age groups, males showed superior or equal need for spine surgery. The socioeconomic impact of spondylolisthesis in Italy is relevant, affecting patients still in the working population. The increasing trend of spine surgery for spondylolisthesis in Italy may be attributable to the widespread diffusion of modern diagnostic and surgical technologies. Level II.

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.

Which patients benefit most from surgery for degenerative spondylolisthesis? Predictors of treatment effect in a large multicentre prospective study

Which patients benefit most from surgery for degenerative spondylolisthesis? Predictors of treatment effect in a large multicentre prospective study

UNEXPLAINED UNILATERAL LOWER LIMB NEUROLOGICAL DEFICITS AFTER POSTERIOR SPINAL DECOMPRESSION AND FUSION FOR DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

The observational data from the Spine Patient Outcomes Research Trial (SPORT) confirm the superiority of surgical over conservative management of symptomatic degenerative spondylolisthesis. The most common reported neurologic complications after lumbar posterior decompression and fusion are implant malposition, contralateral foraminal stenosis, hematoma/seroma, arachnoiditis, and nerve root oedema or vascular underlying causes. The current study reported that the patient developed unexpected left side neurological deficit after conventional lumbar posterior spinal decompression surgery for degenerative spondylolisthesis. No intraoperative dural insult. The computer topography (CT) scan and magnetic resonance imaging (MRI) of the spine after index surgery show adequate canal and foraminal decompression. No hardware-related complications or compressive hematoma could explain the patient’s symptoms. The patient recovered completely after removing the redundant posterolateral bone graft. The theory behind that is aggressive posterolateral dissection over the transverse process and abundant application of the bone graft might compress or injure the lumbar plexus. So, we suggested a delicate dissection posterolaterally and only a reasonable amount of bone graft could be applied to prevent such a devastating neurological complication.

Examining the Role of Paraspinal Musculature in Postoperative Disability After Lumbar Fusion Surgery for Degenerative Spondylolisthesis.

Retrospective analysis of prospectively enrolled patients. To evaluate the relationship between paraspinal muscle (PM) atrophy and Oswestry Disability Index (ODI) improvement after spinal fusion surgery for degenerative lumbar spondylolisthesis. Atrophy of the PM is linked to multiple spinal conditions, sagittal malalignment, and increased postoperative complications. However, only limited evidence for the effect on patient-reported outcomes exists. Patients with degenerative lumbar spondylolisthesis undergoing decompression and fusion surgery were analyzed. Patients with missing follow-up, no imaging, or inadequate image quality were excluded. The ODI was assessed preoperatively and two years postoperatively. A cross-sectional area of the PM was measured on a T2-weighted magnetic resonance imaging sequence at the upper endplate of L4. On the basis of the literature, a 10-point improvement cutoff was defined as the minimum clinically important difference. Patients with a baseline ODI below the minimum clinically important difference were excluded. Logistic regression was used to calculate the association between fatty infiltration (FI) of the PM and improvement in ODI, adjusted for age, sex, and body mass index. A total of 133 patients were included in the final analysis, with only two lost to follow-up. The median age was 68 years (IQR 62-73). The median preoperative ODI was 23 (IQR 17-28), and 76.7% of patients showed improvement in their ODI score by at least 10 points. In the multivariable regression, FI of the erector spinae and multifidus increased the risk of not achieving clinically relevant ODI improvement ( P =0.01 and <0.001, respectively). No significant association was found for the psoas muscle ( P =0.158). This study demonstrates that FI of the erector spinae and multifidus is significantly associated with less likelihood of clinically relevant ODI improvement after decompression and fusion. Further research is needed to assess the effect of interventions.

Functional &amp; Clinical Outcomes of Posterior Decompression &amp; Transforaminal Lumbar Interbody Fusion (TLIF) Using Cage and Bone Graft Combined with Stabilization in Lumbar Spondylolisthesis

Introduction: Posterior decompression and transforaminal lumbar interbody fusion (TLIF) using cage and bone graft is a surgical technique for treating lumbar spondylolisthesis. This procedure aims to relieve spinal pressure and stabilize the affected vertebral segments. Aim of the study: The aim of this study was to assess the clinical and functional outcomes of posterior decompression &amp; transforaminal lumbar interbody fusion (TLIF) using cage and bone graft combined with stabilization in lumbar spondylolisthesis. Methods: This prospective observational study was carried out at NITOR, Dhaka, Bangladesh, during the period from January 2020 to December 2021. Total 15 patients with degenerative lumbar spondylolisthesis were included in this study. Result: The study assessed 15 patients undergoing surgery for spondylolisthesis, primarily aged 40-49, with a mean age of 46.4 years. Gender distribution was 40% male, 60% female. Pre-operative spondylolisthesis was mostly at L4/L5 (60%) and L5/S1 (40%). Post-op data showed significant reductions in slip angle and VAS scores for back and leg pain (all P&lt;0.05). Foraminal and disc space height increased. Fusion rate was 86.66% per Hackenberg criteria. Motor deficit improved from 33.3% to 6.7% post-op. According to Macnab criteria, 73% had excellent functional outcomes and 26.66% experienced minor complications; no major complications were recorded. Conclusion: As observed from the result of this study, degenerative lumber spondylolisthesis can be treated with posterior decompression and transforaminal lumbar interbody fusion by using cage and bone graft with spinal stabilization. This method enhances neurological recovery, reduces pain and makes the patients able to return to work comfortably.

Wearable technology and measurement of outcomes from lumbar spondylolisthesis surgery

Accurate assessment markers are crucial in the management of lumbar spondylolisthesis, particularly after surgical intervention. Traditional methods to track surgical outcomes primarily rely on patient-reported outcome measures (PROMs), which capture patients’ perspectives on their health and recovery. However, PROMs are subjective and susceptible to bias, affecting their reliability. To overcome these limitations, wearable devices have emerged as valuable tools for tracking real-life mobility and objectively assessing surgical outcomes. These devices provide continuous, remote collection of various health metrics and have been shown to have high efficacy and patient compliance. This chapter reviews the current landscape of combining wearable technology data and PROMs in assessing lumbar surgery outcomes, with a focus on spondylolisthesis patients. Both objective physical activity data and subjective clinical scores demonstrate similar trends in postoperative recovery. However, attempts to correlate these metrics have produced mixed results due to the variation in devices and PROMs used. Establishing standardized protocols for wearable usage and data reporting is crucial for maximizing their utility in monitoring spine patients effectively. Overall, integrating wearable technology with PROMs holds significant potential to enhance postoperative monitoring, improve personalized care, and optimize patient recovery. Future applications may involve predicting outcomes and tailoring interventions based on objective activity data in the early postoperative stage, ultimately leading to better patient outcomes and improved healthcare delivery.

Percutaneous transforaminal endoscopic surgery (PTES) and mini-incision L5/S1 OLIF with a self-lock cage for the surgical treatment of L5 spondylolisthesis

ObjectivesWe reported thirteen cases of percutaneous transforaminal endoscopic surgery (PTES) under local anesthesia and mini-incision L5/S1 OLIF (OLIF51) with a self-lock cage for the treatment of L5 spondylolisthesis.MethodsFrom Jan 2019 to Feb 2020, the patients with L5 spondylolisthesis with nerve root symptoms undergoing PTES and OLIF51 were included in this study. PTES under local anesthesia was performed in a prone position, and OLIF51 with a self-lock cage and allograft was then undertaken through a left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using the VAS, and the clinical outcomes were evaluated with the ODI before surgery and at the 2-year follow-up. The anterior and posterior intervertebral space height (AISH, PISH), lumbar lordotic, and surgical segmental lordotic angle (SLA) were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to Bridwell’s fusion grades.ResultsThirteen cases of L5 spondylolisthesis were included. The operation duration was 49.1 ± 5.6 min for PTES and 73.6 ± 8.2 min for OLIF. There was blood loss of 25 (15–45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5 (4–6) days, and the follow-up duration was 29 (24–37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001), and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). AISH, PISH and SLA significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at the 2-year follow-up were grade I in 9 segments (69.2%) and grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage or major complications. No failure of instruments was observed.ConclusionsPTES and mini-incision OLIF51 with a self-lock cage is a viable option of minimally invasive surgery for L5 spondylolisthesis, which can achieve direct neurologic decompression, satisfactory fusion and hardly destroys the rectus abdominis and its sheath, paraspinal muscles and bone structures.

A systematic review and meta-analysis of risk factors for reoperation after degenerative lumbar spondylolisthesis surgery

BackgroundConsidering the high reoperation rate in degenerative lumbar spondylolisthesis (DLS) patients undergoing lumbar surgeries and controversial results on the risk factors for the reoperation, we performed a systematic review and meta-analysis to explore the reoperation rate and risk factors for the reoperation in DLS patients undergoing lumbar surgeries.MethodsLiterature search was conducted from inception to October 28, 2022 in Pubmed, Embase, Cochrane Library, and Web of Science. Odds ratio (OR) was used as the effect index for the categorical data, and effect size was expressed as 95% confidence interval (CI). Heterogeneity test was performed for each outcome effect size, and subgroup analysis was performed based on study design, patients, surgery types, follow-up time, and quality of studies to explore the source of heterogeneity. Results of all outcomes were examined by sensitivity analysis. Publication bias was assessed using Begg test, and adjusted using trim-and-fill analysis.ResultsA total of 39 cohort studies (27 retrospective cohort studies and 12 prospective cohort studies) were finally included in this systematic review and meta-analysis. The overall results showed a 10% (95%CI: 8%-12%) of reoperation rate in DLS patients undergoing lumbar surgeries. In surgery types subgroup, the reoperation rate was 11% (95%CI: 9%-13%) for decompression, 10% (95%CI: 7%-12%) for fusion, and 9% (95%CI: 5%-13%) for decompression and fusion. An increased risk of reoperation was found in patients with obesity (OR = 1.91, 95%CI: 1.04–3.51), diabetes (OR = 2.01, 95%CI: 1.43–2.82), and smoking (OR = 1.51, 95%CI: 1.23–1.84).ConclusionsWe found a 10% of reoperation rate in DLS patients after lumbar surgeries. Obesity, diabetes, and smoking were risk factors for the reoperation.

Pregnancy and delivery after lumbosacral junction fixation: A clinical observation

The clinical signs of spondylolysis and spondylolisthesis most commonly appear at a young age in professional athletes and ballet dancers. The development and improvement of diagnostic methods and surgical treatment techniques for these pathologies lead to an increase in the number of patients of reproductive age with implants in the lumbosacral junction. A multidisciplinary approach in the management of pregnancy and determination of the delivery method in women with this pathology allows for safe reduction in the incidence of unwarranted operative delivery without worsening maternal and perinatal outcomes. This study presents the clinical case of a patient who had surgery for spondylolysis and spondylolisthesis and delivered successfully through natural childbirth at full-term gestation.

Functional outcomes correlate with sagittal spinal balance in degenerative lumbar spondylolisthesis surgery

BACKGROUND CONTEXTDegenerative lumbar spondylolisthesis (DLS) is a debilitating condition associated with poor preoperative functional status. Surgical intervention has been shown to improve functional outcomes in this population though the optimal surgical procedure remains controversial. The importance of maintaining and/or improving sagittal and pelvic spinal balance parameters has received increasing interest in the recent DLS literature. However, little is known about the radiographic parameters most associated with improved functional outcomes among patients undergoing surgery for DLS. PURPOSETo identify the effect of postoperative sagittal spinal alignment on functional outcome after DLS surgery. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLETwo-hundred forty-three patients in the Canadian Spine Outcomes and Research Network (CSORN) prospective DLS study database. OUTCOME MEASURESBaseline and 1-year postoperative leg and back pain on the 10-point Numeric Rating Scale and baseline and 1-year postoperative disability on the Oswestry Disability Index (ODI). METHODSAll enrolled study patients had a DLS diagnosis and underwent decompression in isolation or with posterolateral or interbody fusion. Global and regional radiographic alignment parameters were measured at baseline and 1-year postoperatively including sagittal vertical axis (SVA), pelvic incidence and lumbar lordosis (LL). Both univariate and multiple linear regression was used to assess for the association between radiographic parameters and patient-reported functional outcomes with adjustment for possible confounding baseline patient factors. RESULTSTwo-hundred forty-three patients were available for analysis. Among participants, the mean age was 66 with 63% (153/243) female with the primary surgical indication of neurogenic claudication in 197/243 (81%) of patients. Worse pelvic incidence-LL mismatch was correlated with more severe disability [ODI, 0.134, p<.05), worse leg pain (0.143, p<.05) and worse back pain (0.189, p<.001) 1-year postoperatively. These associations were maintained after adjusting for age, BMI, gender, and preoperative presence of depression (ODI, R2 0.179, β, 0.25, 95% CI 0.08, 0.42, p=.004; back pain R2 0.152 (β, 0.05, 95% CI 0.022, 0.07, p<.001; leg pain score R2 0.059, β, 0.04, 95% CI 0.008, 0.07, p=.014). Likewise, reduction of LL was associated with worse disability (ODI, R2 0.168, β, 0.04, 95% CI -0.39, -0.02, p=.027) and worse back pain (R2 0.135, β, -0.04, 95% CI -0.06, -0.01, p=.007). Worsened SVA correlated with worse patient reported functional outcomes (ODI, R2 0.236, β, 0.12, 95% CI 0.05, 0.20, p=.001). Similarly, an increase (worsening) in SVA resulted in a worse NRS back pain (R2 0.136, β, 0.01, 95% CI .001, 0.02, p=.029) and worse NRS leg pain (R2 0.065, β, 0.02, 95% CI 0.002, 0.02, p=.018) scores regardless of surgery type. CONCLUSIONSPreoperative emphasis on regional and global spinal alignment parameters should be considered in order to optimize functional outcome in lumbar degenerative spondylolisthesis treatment.

Anterolateral versus posterior minimally invasive lumbar interbody fusion surgery for spondylolisthesis: comparison of outcomes from a global, multicenter study at 12-months follow-up

BACKGROUND CONTEXTSeveral minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches. PURPOSETo test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery. DESIGNProspective, multicenter, international, observational cohort study. PATIENT SAMPLEPatients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion. OUTCOME MEASURESPatient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months. METHODSEligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison. RESULTSParticipants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390). CONCLUSIONSPatients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.

488 Prospective Evaluation of Racial Disparities in Surgical Treatment Of Degenerative Spondylolisthesis Using PROMIS Pain Interference And Physical Function Scores

INTRODUCTION: Spine surgery for degenerative spondylolisthesis is indicated in patients who remain symptomatic despite a course of nonsurgical therapy. Patient’s report of pain interference and physical function are key indicators for intervention. We know that Black and indigenous patients of color have poorer outcomes in back pain. This study aims to identify trends in intervention for degenerative spondylolisthesis based on race and patient-reported outcomes. METHODS: A prospective cohort study of degenerative spondylolisthesis patients seen in Harvard Medical School-affiliated clinics from 2015 to 2022 and who completed the routinely collected PROMIS patient-reported outcome measures (PROMs): Physical Function (PF) and pain Interference (PI). PROMIS scores are standardized to the U.S. population (mean score = 50). Regression analyses were performed to determine factors associated with treatment assignment. RESULTS: In this study, 22 374 patients (mean Age, 66.91(14.22); Female, 64%; BIPOC, 3019 (13%)) completed PROMs at baseline. Medicaid coverage was more prevalent among BIPOC (13% vs. 3.1%; P &lt; 0.001) who were less likely to receive an interventional treatment (351/ 3,019 (12%) vs. 3,021 / 19,355 (16%); P &lt; 0.001) despite a significantly higher pain interference score (62.32 (8.37) vs. 61.51 (8.35); P &lt; 0.001). White race was associated with higher odds of receiving surgical treatment than BIPOC after adjusting for age, comorbidities, medical coverage, physical function, and pain interference at baseline (OR = 1.20; 95 CI, 1.15-1.26; P &lt; 0.001). CONCLUSIONS: Despite higher pain interference scores, BIPOC patients were less likely to be offered spine surgery for degenerative spondylolisthesis, indicating that race is a predictor of spine surgery after accounting for comorbidities, physical function, and disability at diagnosis.

403 Inferior Clinical Outcomes for Patients with Medicaid Insurance Following Surgery for Degenerative Lumbar Spondylolisthesis: A Prospective Registry Analysis of 608 Patients

INTRODUCTION: It remains unclear how type of insurance coverage impacts long-term, spine-specific patient-reported outcomes (PROs). METHODS: The prospective Quality Outcomes Database registry was queried for patients with grade 1 degenerative lumbar spondylolisthesis who underwent single-segment surgery. 24-month PROs compared included Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EuroQol-5D (EQ-5D), and North American Spine Society (NASS) Satisfaction. RESULTS: 608 patients undergoing surgery for grade 1 degenerative lumbar spondylolisthesis (mean age 62.5 ± 11.5 years and 59.2% women) were selected. Insurance types included private insurance (n = 319, 52.5%), Medicare (n = 235, 38.7%), Medicaid (n = 36, 5.9%), and VA/government (n =17, 2.8%). 1 patient (0.2%) was uninsured and was removed from the analyses. In adjusted multivariable analyses, when compared to patients with private insurance, Medicaid was associated with worse 24-month postoperative ODI β = 10.2, 95% CI 3.9 - 16.5) and NRS-LP β = 1.3, 95% CI 0.3 - 2.4). Medicaid was associated with worse EQ-5D scores compared to private insurance (β = -0.07, 95% CI -0.01 - -0.14), but not when compared to Medicare and VA/government insurance (p &gt; 0.05). Medicaid was associated with lower odds of reaching ODI minimal clinically important difference (OR = 0.2, 95% CI 0.03 - 0.7) compared to VA/government insurance. NRS-BP and NASS satisfaction did not differ by insurance coverage (p &gt; 0.05). CONCLUSIONS: Despite adjusting for potential confounding variables, Medicaid coverage was independently associated with worse 24-month PROs following lumbar spondylolisthesis surgery compared to other payer types. While all improved postoperatively, those with Medicaid coverage had relatively inferior improvements.

Paraspinal muscle gene expression across different aetiologies in individuals undergoing surgery for lumbar spine pathology

PurposeThe purpose of this study was to understand potential baseline transcriptional expression differences in paraspinal skeletal muscle from patients with different underlying lumbar pathologies by comparing multifidus gene expression profiles across individuals with either disc herniation, facet arthropathy, or degenerative spondylolisthesis.MethodsMultifidus biopsies were obtained from patients (n = 44) undergoing lumbar surgery for either disc herniation, facet arthropathy, or degenerative spondylolisthesis. Diagnostic categories were based on magnetic resonance images, radiology reports, and intraoperative reports. Gene expression for 42 genes was analysed using qPCR. A one-way analysis of variance was performed for each gene to determine differences in expression across diagnostic groups. Corrections for multiple comparisons across genes (Benjamini–Hochberg) and for between-group post hoc comparisons (Sidak) were applied.ResultsAdipogenic gene (ADIPOQ) expression was higher in the disc herniation group when compared to the facet arthropathy group (p = 0.032). Adipogenic gene (PPARD) expression was higher in the degenerative spondylolisthesis group when compared to the disc herniation group (p = 0.013), although absolute gene expression levels for all groups was low. Fibrogenic gene (COL3A1) had significantly higher expression in the disc herniation group and facet arthropathy group when compared to the degenerative spondylolisthesis group (p < 0.001 and p = 0.038, respectively). When adjusted for multiple comparisons, only COL3A1 remained significant (p = 0.012).ConclusionIndividuals with disc herniation and facet arthropathy demonstrate higher COL3A1 gene expression compared to those with degenerative spondylolisthesis. Future research is required to further understand the biological relevance of these transcriptional differences.