Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database

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OBJECTIVE

The AANS launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the safety and quality of spine surgery. Registry data offer “real-world” insights into the utility of spinal fusion and decompression surgery for lumbar spondylolisthesis. Using the QOD, the authors compared the initial 12-month outcome data for patients undergoing fusion and those undergoing laminectomy alone for grade 1 degenerative lumbar spondylolisthesis.

METHODS

Data from 12 top enrolling sites were analyzed and 426 patients undergoing elective single-level spine surgery for degenerative grade 1 lumbar spondylolisthesis were found. Baseline, 3-month, and 12-month follow-up data were collected and compared, including baseline clinical characteristics, readmission rates, reoperation rates, and PROs. The PROs included Oswestry Disability Index (ODI), back and leg pain numeric rating scale (NRS) scores, and EuroQol–5 Dimensions health survey (EQ-5D) results.

RESULTS

A total of 342 (80.3%) patients underwent fusion, with the remaining 84 (19.7%) undergoing decompression alone. The fusion cohort was younger (60.7 vs 69.9 years, p < 0.001), had a higher mean body mass index (31.0 vs 28.4, p < 0.001), and had a greater proportion of patients with back pain as a major component of their initial presentation (88.0% vs 60.7%, p < 0.001). There were no differences in 12-month reoperation rate (4.4% vs 6.0%, p = 0.93) and 3-month readmission rates (3.5% vs 1.2%, p = 0.45). At 12 months, both cohorts improved significantly with regard to ODI, NRS back and leg pain, and EQ-5D (p < 0.001, all comparisons). In adjusted analysis, fusion procedures were associated with superior 12-month ODI (β −4.79, 95% CI −9.28 to −0.31; p = 0.04).

CONCLUSIONS

Surgery for grade 1 lumbar spondylolisthesis—regardless of treatment strategy—was associated with significant improvements in disability, back and leg pain, and quality of life at 12 months. When adjusting for covariates, fusion surgery was associated with superior ODI at 12 months. Although fusion procedures were associated with a lower rate of reoperation, there was no statistically significant difference at 12 months. Further study must be undertaken to assess the durability of either surgical strategy in longer-term follow-up.

ABBREVIATIONS BMI = body mass index; EQ-5D = EuroQol–5 Dimensions health survey; MCID = minimum clinically important difference; MIS = minimally invasive surgery; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; SLIP = Spinal Laminectomy versus Instrumented Pedicle Screw; SPORT = Spine Patient Outcomes Research Trial.

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Article Information

Correspondence Praveen V. Mummaneni: University of California, San Francisco, CA. praveen.mummaneni@ucsf.edu.

INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.8.SPINE17913.

Disclosures Dr. Bisson is a consultant for nView. Dr. Foley is a consultant for Medtronic; has direct stock ownership in Discgenics, Medtronic, NuVasive, SpineWave, and TrueVision; and is a patent holder with Medtronic and NuVasive. He also receives royalties for patents from Medtronic. He is on the board of directors for Discgenics and TrueVision. Dr. Fu is a consultant for SI-BONE. Dr. Glassman is an employee of Norton Healthcare. He is a patent holder with, a consultant for, and receives royalties from Medtronic. He is the past president of the Scoliosis Research Society. Dr. Haid has direct stock ownership in NuVasive, SpineWave, and Globus. He is a consultant for NuVasive and receives royalties from that company. He also receives royalties from Medtronic and Globus. He is a patent holder with Medtronic. He is chair of the NREF. Dr. Knightly is on the board of directors for the NPA (NeuroPoint Alliance). Dr. Mummaneni is a consultant for DePuy Spine, Globus, and Stryker, and he has direct stock ownership in Spinicity/ISD. He receives clinical or research support for the study described (includes equipment or material) from the NREF. He receives royalties from DePuy Spine, Thieme Publishing, and Springer Publishing, and honoraria from AOSpine and Spineart. Dr. Park is a consultant for Globus, Medtronic, NuVasive, and Zimmer-Biomet. He receives royalties from Globus. Dr. Potts is a consultant for Medtronic. Dr. Chris Shaffrey is a consultant for Medtronic, NuVasive, and Zimmer-Biomet. He has direct stock ownership in NuVasive, and he is a patent holder with Medtronic, NuVasive, and Zimmer-Biomet. Dr. Slotkin is a consultant for Stryker and Medtronic. Dr. Wang is a patent holder with DePuy-Synthes Spine and Spineology. He is a consultant for DePuy-Synthes Spine, Stryker, K2M, and Globus Medical. He has direct stock ownership in Globus Medical.

© AANS, except where prohibited by US copyright law.

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Figures

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    Artist’s illustrations. A: Degenerative L4–5 grade 1 spondylolisthesis. B: Decompression-only surgery involving L4 and L5 decompressive laminectomies. C: An L4–5 transforaminal lumbar interbody fusion (TLIF), a surgical option that includes a fusion procedure in addition to decompression. Artist: Kenneth Probst. Copyright Department of Neurological Surgery, University of California, San Francisco. Published with permission. Figure is available in color online only.

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    Baseline, 3-month, and 12-month PROs following surgery for grade 1 lumbar spondylolisthesis. A: Average ODI at baseline, 3 months, and 12 months following surgery, by cohort. B: Average NRS back pain scores at baseline, 3 months, and 12 months following surgery, by cohort. C: Average NRS leg pain scores at baseline, 3 months, and 12 months following surgery, by cohort. D: Average EQ-5D at baseline, 3 months, and 12 months following surgery, by cohort. The error bars represent 1 SD. For both cohorts there were statistically significant improvements at 3- and 12-month follow-up, relative to baseline, for NRS back and leg pain, ODI, and EQ-5D (p < 0.001, all comparisons). At baseline, the fusion cohort had significantly worse ODI (p < 0.001), NRS back pain (p = 0.002), and EQ-5D (p = 0.01) without significant differences in NRS leg pain. Aside from 3-month EQ-5D (p = 0.002), there were no significant between-group differences with regard to each PRO at 3 months and 12 months.

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