Factors associated with using an interbody fusion device for low-grade lumbar degenerative versus isthmic spondylolisthesis: a retrospective cohort study

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  • 1 Division of Orthopaedics, Department of Surgery, Western University/London Health Sciences Centre, London, Ontario;
  • | 2 Lawson Health Research Institute, London, Ontario;
  • | 3 Department of Surgery, University of Toronto, Ontario;
  • | 4 Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia;
  • | 5 Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick;
  • | 6 Department of Surgery, University of Calgary, Alberta;
  • | 7 Department of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba;
  • | 8 Department of Orthopedics and Neurosurgery, Dalhousie University, Halifax, Nova Scotia;
  • | 9 Department of Surgery, Ottawa University, Ottawa, Ontario;
  • | 10 Department of Surgery, Laval University, Quebec City, Quebec; and
  • | 11 Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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OBJECTIVE

Many studies have utilized a combined cohort of patients with degenerative spondylolisthesis (DS) and isthmic spondylolisthesis (IS) to evaluate indications and outcomes. Intuitively, these are very different populations, and rates, indications, and outcomes may differ. The goal of this study was to compare specific patient characteristics associated with the utilization of a posterior lumbar interbody device between cohorts of patients with DS and IS, as well as to compare rates of interbody device use and patient-rated outcomes at 1 year after surgical treatment.

METHODS

The authors included patients who underwent posterior lumbar interbody fusion or instrumented posterolateral fusion for grade I or II DS or IS and had been enrolled in the Canadian Spine Outcomes and Research Network registry from 2009 to 2016. The outcome measures were score on the Oswestry Disability Index, scores for back pain and leg pain on the numeric rating scale, and mental component summary (MCS) score and physical component summary score on the 12-Item Short-Form Health Survey. Descriptive statistics were used to compare spondylolisthesis groups, logistic regression was used to compare interbody device use, and the chi-square test was used to compare the proportions of patients who achieved a minimal clinically important difference (MCID) at 1 year after surgery.

RESULTS

In total, 119 patients had IS and 339 had DS. Patients with DS were more commonly women, older, less likely to smoke, and more likely to have neurogenic claudication and comorbidities, whereas patients with IS more commonly had radicular pain, neurological deficits, and worse back pain. Spondylolisthesis was more common at the L4–5 level in patients with DS and at the L5–S1 level in patients with IS. Similar proportions of patients had an interbody device (78.6% of patients with DS vs 82.4% of patients with IS, p = 0.429). Among patients with IS, factors associated with interbody device utilization were BMI ≥ 30 kg/m2 and increased baseline leg pain intensity. Factors associated with interbody device utilization in patients with DS were younger age, increased number of total comorbidities, and lower baseline MCS score. For each outcome measure, similar proportions of patients in the surgical treatment and spondylolisthesis groups achieved the MCID at 1 year after surgery.

CONCLUSIONS

Although the demographic and patient characteristics associated with interbody device utilization differed between cohorts, similar proportions of patients attained clinically meaningful improvement at 1 year after surgery.

ABBREVIATIONS

CSORN = Canadian Spine Outcomes and Research Network; DS = degenerative spondylolisthesis; IS = isthmic spondylolisthesis; MCID = minimal clinically important difference; MCS = mental component summary; NRS = numeric rating scale; ODI = Oswestry Disability Index; PCS = physical component summary; PIBF = posterior interbody fusion; PLF = posterolateral fusion; PROM = patient-reported outcome measure; ROC = receiver operating characteristic; SF-12 = 12-Item Short-Form Health Survey.
Figure from Funaba et al. (pp 308–319).

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Contributor Notes

Correspondence Christopher S. Bailey: The University of Western Ontario, London Health Sciences Centre, London, ON, Canada. chris.bailey@lhsc.on.ca.

INCLUDE WHEN CITING Published online July 2, 2021; DOI: 10.3171/2020.11.SPINE201261.

Disclosures CSORN is sponsored by the Canadian Spine Education and Research Fund through contributions from Medtronic and DePuy Synthes. Dr. Fisher is a consultant for Medtronic and NuVasive; receives royalties from Medtronic; and receives fellowship support paid to an institution from Medtronic and AO Spine. Dr. Johnson receives clinical or research support for the study described from Stryker. Dr. Yee receives support for academic research and education at a hospital/university from Zimmer Biomet, DePuy Synthes, Stryker, and Medtronic; and receives honoria from Medtronic. Dr. Manson is a consultant for and receives support for non–study-related clinical or research effort from Medtronic Canada. Dr. Rampersaud is a consultant for and receives royalties from Medtronic.

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