Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database

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  • 1 Department of Neurological Surgery, University of Utah, Salt Lake City, Utah;
  • 2 Department of Neurological Surgery, University of California, San Francisco, California;
  • 3 Department of Neurological Surgery, Weill Cornell Medical College, New York, New York;
  • 4 Atlantic Neurosurgical Specialists, Morristown, New Jersey;
  • 5 Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;
  • 6 Norton Leatherman Spine Center, Louisville, Kentucky;
  • 7 Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;
  • 8 Geisinger Health System, Danville, Pennsylvania;
  • 9 Goodman Campbell Brain and Spine, Indianapolis, Indiana;
  • 10 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • 11 Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, North Carolina;
  • 12 Atlanta Brain and Spine, Atlanta, Georgia;
  • 13 Department of Neurologic Surgery, University of Miami, Florida;
  • 14 Department of Neurologic Surgery, University of Michigan, Ann Arbor, Michigan; and
  • 15 Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina
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OBJECTIVE

Lumbar decompression without arthrodesis remains a potential treatment option for cases of low-grade spondylolisthesis (i.e., Meyerding grade I). Minimally invasive surgery (MIS) techniques have recently been increasingly used because of their touted benefits including lower operating time, blood loss, and length of stay. Herein, the authors analyzed patients enrolled in a national surgical registry and compared the baseline characteristics and postoperative clinical and patient-reported outcomes (PROs) between patients undergoing open versus MIS lumbar decompression.

METHODS

The authors queried the Quality Outcomes Database for patients with grade I lumbar degenerative spondylolisthesis undergoing a surgical intervention between July 2014 and June 2016. Among more than 200 participating sites, the 12 with the highest enrollment of patients into the lumbar spine module came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthesis. For the current study, only patients in this cohort from the 12 highest-enrolling sites who underwent a decompression alone were evaluated and classified as open or MIS (tubular decompression). Outcomes of interest included PROs at 2 years; perioperative outcomes such as blood loss and complications; and postoperative outcomes such as length of stay, discharge disposition, and reoperations.

RESULTS

A total of 140 patients undergoing decompression were selected, of whom 71 (50.7%) underwent MIS and 69 (49.3%) underwent an open decompression. On univariate analysis, the authors observed no significant differences between the 2 groups in terms of PROs at 2-year follow-up, including back pain, leg pain, Oswestry Disability Index score, EQ-5D score, and patient satisfaction. On multivariable analysis, compared to MIS, open decompression was associated with higher satisfaction (OR 7.5, 95% CI 2.41–23.2, p = 0.0005). Patients undergoing MIS decompression had a significantly shorter length of stay compared to the open group (0.68 days [SD 1.18] vs 1.83 days [SD 1.618], p < 0.001).

CONCLUSIONS

In this multiinstitutional prospective study, the authors found comparable PROs as well as clinical outcomes at 2 years between groups of patients undergoing open or MIS decompression for low-grade spondylolisthesis.

ABBREVIATIONS ASA = American Society of Anesthesiologists; BMI = body mass index; MIS = minimally invasive surgery; NASS = North American Spine Society; NRS = numeric rating scale; ODI = Oswestry Disability Index; OL = open laminectomy; PRO = patient-reported outcome; QOD = Quality Outcomes Database.

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Contributor Notes

Correspondence Mohamad Bydon: Mayo Clinic, Rochester, MN. bydon.mohamad@mayo.edu.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.3.SPINE191239.

Disclosures Dr. Bisson is a consultant for Stryker, nView, and MiRus. She has direct stock ownership in MiRus. Dr. Chan receives support from Orthofix, Inc., for a non–study-related clinical or research effort that he oversees. Dr. Foley is a consultant for Medtronic. He has direct stock ownership in Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, Medtronic, NuVasive, Practical Navigation/Fusion Robotics, SpineWave, TDi, and Triad Life Sciences. He holds patents with Medtronic and NuVasive, and he receives royalties from Medtronic. He is on the boards of directors of Digital Surgery Systems, Discgenics, DuraStat, LaunchPad Medical, Practical Navigation/Fusion Robotics, TDi, and Triad Life Sciences. Dr. Fu is a consultant for SI Bone, Globus, and Johnson & Johnson. Dr. Glassman is a consultant for Medtronic and K2M/Stryker. He receives royalties from and is a patent holder with Medtronic. He received clinical or research support for the study described (includes equipment and material) from Intellirod Spine, Inc., Pfizer, Cerapedics, Inc., the Scoliosis Research Society, and Medtronic. He is an employee of Norton Healthcare. He is chair of the American Spine Registry and past president of the Scoliosis Research Society. Dr. Haid receives royalties from Globus Medical, Medtronic, and NuVasive. He is a shareholder in Globus Medical, NuVasive, Paradigm Spine, SpineWave, and VerticalHealth (SpineUniverse). Dr. Knightly is the chairperson of NeuroPoint Alliance. Dr. Mummaneni is a consultant for DePuy Synthes, Globus, and Stryker. He has direct stock ownership in Spinicity/ISD. He received clinical or research support for the study described (includes equipment and material) from NREF. He receives support from AOSpine for a non–study-related clinical or research effort that he oversees. He receives royalties from Thieme Publishers, Springer Publishers, and DePuy Synthes. Dr. Park is a consultant for Globus Medical and NuVasive, and he receives royalties from Globus Medical. He receives support from DePuy for a non–study-related clinical or research effort that he oversees. Dr. Potts is a patent holder with and a consultant for Medtronic. Dr. C. I. Shaffrey is a consultant for NuVasive, Medtronic, SI Bone, and Siemens. He has direct stock ownership in NuVasive and Zimmer Biomet, and he is a patent holder with NuVasive and Medtronic. Dr. Virk is a consultant for DePuy Synthes, Globus Medical, and BrainLab, Inc. Dr. Wang is a consultant for DePuy Synthes Spine, Stryker, and Spineology. He is a patent holder with DePuy Synthes Spine, and he has direct stock ownership in ISD and Medical Device Partners.

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