Patient-reported outcome improvements at 24-month follow-up after fusion added to decompression for grade I degenerative lumbar spondylolisthesis: a multicenter study using the Quality Outcomes Database

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

The ideal surgical management of grade I lumbar spondylolisthesis has not been determined despite extensive prior investigations. In this cohort study, the authors used data from the large, multicenter, prospectively collected Quality Outcomes Database to bridge the gap between the findings in previous randomized trials and those in a more heterogeneous population treated in a typical practice. The objective was to assess the difference in patient-reported outcomes among patients undergoing decompression alone or decompression plus fusion.

METHODS

The primary outcome measure was change in 24-month Oswestry Disability Index (ODI) scores. The minimal clinically important difference (MCID) in ODI score change and 30% change in ODI score at 24 months were also evaluated. After adjusting for patient-specific and clinical factors, multivariable linear and logistic regressions were employed to evaluate the impact of fusion on outcomes. To account for differences in age, sex, body mass index, and baseline listhesis, a sensitivity analysis was performed using propensity score analysis to match patients undergoing decompression only with those undergoing decompression and fusion.

RESULTS

In total, 608 patients who had grade I lumbar spondylolisthesis were identified (85.5% with at least 24 months of follow-up); 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-month change in ODI score was significantly greater in the fusion plus decompression group than in the decompression-only group (−25.8 ± 20.0 vs −15.2 ± 19.8, p < 0.001). Fusion remained independently associated with 24-month ODI score change (B = −7.05, 95% CI −10.70 to −3.39, p ≤ 0.001) in multivariable regression analysis, as well as with achieving the MCID for the ODI score (OR 1.767, 95% CI 1.058–2.944, p = 0.029) and 30% change in ODI score (OR 2.371, 95% CI 1.286–4.371, p = 0.005). Propensity score analysis resulted in 94 patients in the decompression-only group matched 1 to 1 with 94 patients in the fusion group. The addition of fusion to decompression remained a significant predictor of 24-month change in the ODI score (B = 2.796, 95% CI 2.228–13.275, p = 0.006) and of achieving the 24-month MCID ODI score (OR 2.898, 95% CI 1.214–6.914, p = 0.016) and 24-month 30% change in ODI score (OR 2.300, 95% CI 1.014–5.216, p = 0.046).

CONCLUSIONS

These results suggest that decompression plus fusion in patients with grade I lumbar spondylolisthesis may be associated with superior outcomes at 24 months compared with decompression alone, both in reduction of disability and in achieving clinically meaningful improvement. Longer-term follow-up is warranted to assess whether this effect is sustained.

ABBREVIATIONS MCID = minimal clinically important difference; NASS = North American Spine Society; 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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Contributor Notes

Correspondence Erica F. Bisson: University of Utah, Salt Lake City, UT. neuropub@hsc.utah.edu.

INCLUDE WHEN CITING Published online April 16, 2021; DOI: 10.3171/2020.9.SPINE201082.

Disclosures Dr. Bisson owns stock in and serves as a consultant for Mirus and NView, is a consultant for Stryker, and receives funding from PCORI. Dr. Glassman is an employee of Norton Healthcare, is a consultant for K2M/Stryker and Medtronic, is chair of the American Spine Registry and past president of the Scoliosis Research Society, holds a patent and receives royalties from K2M/Stryker, and receives royalties from Medtronic and Springer. Dr. Foley is a consultant for, receives royalties from, holds a patent with, and owns stock in Medtronic; owns stock in and is a member of the board of directors for Discgenics, LaunchPad Medical, Fusion Robotics, and Triad Life Sciences; and owns stock in Spine Wave and NuVasive. Dr. Potts is a consultant for and receives royalties from Medtronic. Dr. C. Shaffrey has grants from the ISSG Foundation, AO Spine, and the US Department of Defense and has received personal fees from NuVasive, Medtronic, SI Bone, and Zimmer Biomet. Dr. Coric is a consultant for Spine Wave, Stryker, Medtronic, Globus Medical, Integrity Implant, and Premia Spine; owns stock in Spine Wave and Premia Spine; and receives royalties from Medtronic, Globus Medical, Spine Wave, and Integrity Implant. Dr. Park is a consultant for Globus and NuVasive, is a past consultant to AlloSource and Medtronic, receives royalties from Globus, and has grants to his institution from DePuy Synthes, Pfizer, Vertex, and ISSG. Dr. Wang is a consultant for DePuy Synthes Spine, Spineology, and Stryker; receives royalties from Children’s Hospital of Los Angeles, DePuy Synthes Spine, Springer Publishing, and Quality Medical Publishing; is on the speakers bureau for Medtronic and Globus; and is a stockholder in Innovative Surgical Devices and Medical Device Partners. Dr. Fu has grants from Globus, Johnson & Johnson, and SI Bone. Dr. Slotkin is a consultant for Stryker Spine and Medtronic. Dr. Virk is a consultant for Brainlab Inc., DePuy Synthes, and Globus Medical. Dr. Chan receives research support for unrelated research from Orthofix Medical Inc. Dr. Mummaneni is a consultant for DePuy Spine; receives honoraria from Globus and AO Spine; receives royalties from Thieme, Taylor & Francis, and Springer; is a director at large for SRS; and owns stock in Spinicity ISD.

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