Does reduction of the Meyerding grade correlate with outcomes in patients undergoing decompression and fusion for grade I degenerative lumbar spondylolisthesis?

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

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

OBJECTIVE

Reduction of Meyerding grade is often performed during fusion for spondylolisthesis. Although radiographic appearance may improve, correlation with patient-reported outcomes (PROs) is rarely reported. In this study, the authors’ aim was to assess the impact of spondylolisthesis reduction on 24-month PRO measures after decompression and fusion surgery for Meyerding grade I degenerative lumbar spondylolisthesis.

METHODS

The Quality Outcomes Database (QOD) was queried for patients undergoing posterior lumbar fusion for spondylolisthesis with a minimum 24-month follow-up, and quantitative correlation between Meyerding slippage reduction and PROs was performed. Baseline and 24-month PROs, including the Oswestry Disability Index (ODI), EQ-5D, Numeric Rating Scale (NRS)–back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society patient satisfaction questionnaire) scores were noted. Multivariable regression models were fitted for 24-month PROs and complications after adjusting for an array of preoperative and surgical variables. Data were analyzed for magnitude of slippage reduction and correlated with PROs. Patients were divided into two groups: < 3 mm reduction and ≥ 3 mm reduction.

RESULTS

Of 608 patients from 12 participating sites, 206 patients with complete data were identified in the QOD and included in this study. Baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts except for depression, listhesis magnitude, and the proportion with dynamic listhesis (which were accounted for in the multivariable analysis). One hundred four (50.5%) patients underwent lumbar decompression and fusion with slippage reduction ≥ 3 mm (mean 5.19, range 3 to 11), and 102 (49.5%) patients underwent lumbar decompression and fusion with slippage reduction < 3 mm (mean 0.41, range 2 to −2). Patients in both groups (slippage reduction ≥ 3 mm, and slippage reduction < 3 mm) reported significant improvement in all primary patient reported outcomes (all p < 0.001). There was no significant difference with regard to the PROs between patients with or without intraoperative reduction of listhesis on univariate and multivariable analyses (ODI, EQ-5D, NRS-BP, NRS-LP, or satisfaction). There was no significant difference in complications between cohorts.

CONCLUSIONS

Significant improvement was found in terms of all PROs in patients undergoing decompression and fusion for lumbar spondylolisthesis. There was no correlation with clinical outcomes and magnitude of Meyerding slippage reduction.

ABBREVIATIONS

MCID = minimal clinically important difference; NASS = North American Spine Society; NRS = Numeric Rating Scale; NRS-BP = NRS for back pain; NRS-LP = NRS for leg pain; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Kalichman L, Kim DH, Li L, et al. Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population. Spine (Phila Pa 1976). 2009;34(2):199205.

    • Search Google Scholar
    • Export Citation
  • 2

    Jacobsen S, Sonne-Holm S, Rovsing H, et al. Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study. Spine (Phila Pa 1976). 2007;32(1):120125.

    • Search Google Scholar
    • Export Citation
  • 3

    Samuel AM, Moore HG, Cunningham ME. Treatment for degenerative lumbar spondylolisthesis: current concepts and new evidence. Curr Rev Musculoskelet Med. 2017;10(4):521529.

    • Search Google Scholar
    • Export Citation
  • 4

    Newman P, Stone K. The etiology of spondylolisthesis. J Bone Joint Surg Br. 1963;45-B:3959.

  • 5

    Matsunaga S, Ijiri K, Hayashi K. Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study. J Neurosurg. 2000;93(2)(suppl):194198.

    • Search Google Scholar
    • Export Citation
  • 6

    Chan AK, Bisson EF, Bydon M, et al. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2018;30(2):234241.

    • Search Google Scholar
    • Export Citation
  • 7

    Försth P, Ólafsson G, Carlsson T, et al. A randomized, controlled trial of fusion surgery for lumbar spinal stenosis. N Engl J Med. 2016;374(15):14131423.

    • Search Google Scholar
    • Export Citation
  • 8

    Ghogawala Z, Dziura J, Butler WE, et al. Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med. 2016;374(15):14241434.

    • Search Google Scholar
    • Export Citation
  • 9

    Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356(22):22572270.

    • Search Google Scholar
    • Export Citation
  • 10

    Audat ZM, Darwish FT, Al Barbarawi MM, et al. Surgical management of low grade isthmic spondylolisthesis; a randomized controlled study of the surgical fixation with and without reduction. Scoliosis. 2011;6(1):14.

    • Search Google Scholar
    • Export Citation
  • 11

    Benli IT, Ciçek H, Kaya A. Comparison of sagittal plane realignment and reduction with posterior instrumentation in developmental low or high dysplastic spondylolisthesis. Kobe J Med Sci. 2006;52(6):151169.

    • Search Google Scholar
    • Export Citation
  • 12

    Frennered AK, Danielson BI, Nachemson AL, Nordwall AB. Midterm follow-up of young patients fused in situ for spondylolisthesis. Spine (Phila Pa 1976). 1991;16(4):409416.

    • Search Google Scholar
    • Export Citation
  • 13

    Jenkins JA. Spondylolisthesis. Br J Surg. 1936;24(93):8085.

  • 14

    Kawakami M, Tamaki T, Ando M, et al. Lumbar sagittal balance influences the clinical outcome after decompression and posterolateral spinal fusion for degenerative lumbar spondylolisthesis. Spine (Phila Pa 1976). 2002;27(1):5964.

    • Search Google Scholar
    • Export Citation
  • 15

    Kong C, Wang W, Li X, et al. A new lever reduction technique for the surgical treatment of elderly patients with lumbar degenerative Spondylolisthesis. BMC Musculoskelet Disord. 2020;21(1):11.

    • Search Google Scholar
    • Export Citation
  • 16

    Lak AM, Abunimer AM, Devi S, et al. Reduction versus in situ fusion for adult high-grade spondylolisthesis: a systematic review and meta-analysis. World Neurosurg. 2020;138:512520.e2.

    • Search Google Scholar
    • Export Citation
  • 17

    Lian XF, Hou TS, Xu JG, et al. Single segment of posterior lumbar interbody fusion for adult isthmic spondylolisthesis: reduction or fusion in situ. Eur Spine J. 2014;23(1):172179.

    • Search Google Scholar
    • Export Citation
  • 18

    Lian XF, Hou TS, Xu JG, et al. Posterior lumbar interbody fusion for aged patients with degenerative spondylolisthesis: is intentional surgical reduction essential?. Spine J. 2013;13(10):11831189.

    • Search Google Scholar
    • Export Citation
  • 19

    Transfeldt EE, Mehbod AA. Evidence-based medicine analysis of isthmic spondylolisthesis treatment including reduction versus fusion in situ for high-grade slips. Spine (Phila Pa 1976). 2007;32(19)(suppl):S126S129.

    • Search Google Scholar
    • Export Citation
  • 20

    Verbiest H. The treatment of lumbar spondyloptosis or impending lumbar spondyloptosis accompanied by neurologic deficit and/or neurogenic intermittent claudication. Spine (Phila Pa 1976). 1979;4(1):6877.

    • Search Google Scholar
    • Export Citation
  • 21

    Meyerding HW. Diagnosis and roentgenologic evidence in spondylolisthesis. Radiology. 1933;20(2):108120.

  • 22

    Asher AL, Kerezoudis P, Mummaneni PV, et al. Defining the minimum clinically important difference for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus. 2018;44(1):E2.

    • Search Google Scholar
    • Export Citation
  • 23

    Asher AL, Knightly J, Mummaneni PV, et al. Quality Outcomes Database Spine Care Project 2012-2020: milestones achieved in a collaborative North American outcomes registry to advance value-based spine care and evolution to the American Spine Registry. Neurosurg Focus. 2020;48(5):E2.

    • Search Google Scholar
    • Export Citation
  • 24

    Bisson EF, Mummaneni PV, Knightly J, et al. Assessing the differences in characteristics of patients lost to follow-up at 2 years: results from the Quality Outcomes Database study on outcomes of surgery for grade I spondylolisthesis. J Neurosurg Spine. 2020;33(5):643651.

    • Search Google Scholar
    • Export Citation
  • 25

    Bisson EF, Mummaneni PV, Virk MS, et al. Open versus minimally invasive decompression for low-grade spondylolisthesis: analysis from the Quality Outcomes Database. J Neurosurg Spine. 2020;33(3):349359.

    • Search Google Scholar
    • Export Citation
  • 26

    Chan AK, Bisson EF, Bydon M, et al. A comparison of minimally invasive and open transforaminal lumbar interbody fusion for grade 1 degenerative lumbar spondylolisthesis: an analysis of the prospective Quality Outcomes Database. Neurosurgery. 2020;87(3):555562.

    • Search Google Scholar
    • Export Citation
  • 27

    Chan AK, Bisson EF, Bydon M, et al. Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database. Neurosurg Focus. 2018;44(1):E3.

    • Search Google Scholar
    • Export Citation
  • 28

    Chan AK, Bisson EF, Bydon M, et al. A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis. Neurosurg Focus. 2019;46(5):E13.

    • Search Google Scholar
    • Export Citation
  • 29

    Chan AK, Bisson EF, Bydon M, et al. Obese patients benefit, but do not fare as well as nonobese patients, following lumbar spondylolisthesis surgery: an analysis of the Quality Outcomes Database. Neurosurgery. 2020;86(1):8087.

    • Search Google Scholar
    • Export Citation
  • 30

    Chan AK, Bisson EF, Bydon M, et al. Predictors of the best outcomes following minimally invasive surgery for grade 1 degenerative lumbar spondylolisthesis. Neurosurgery. 2020;87(6):11301138.

    • Search Google Scholar
    • Export Citation
  • 31

    Chan AK, Bisson EF, Fu KM, et al. Sexual dysfunction: prevalence and prognosis in patients operated for degenerative lumbar spondylolisthesis. Neurosurgery. 2020;87(2):200210.

    • Search Google Scholar
    • Export Citation
  • 32

    DiGiorgio AM, Mummaneni PV, Park P, et al. Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the Quality Outcomes Database. Neurosurg Focus. 2020;48(5):E5.

    • Search Google Scholar
    • Export Citation
  • 33

    Karsy M, Chan AK, Mummaneni PV, et al. Outcomes and complications with age in spondylolisthesis: an evaluation of the elderly from the Quality Outcomes Database. Spine (Phila Pa 1976). 2020;45(14):10001008.

    • Search Google Scholar
    • Export Citation
  • 34

    Kashlan O, Swong K, Alvi MA, et al. Patients with a depressive and/or anxiety disorder can achieve optimum Long term outcomes after surgery for grade 1 spondylolisthesis: analysis from the quality outcomes database (QOD). Clin Neurol Neurosurg. 2020;197:106098.

    • Search Google Scholar
    • Export Citation
  • 35

    Mummaneni PV, Bisson EF, Kerezoudis P, et al. Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database. Neurosurg Focus. 2017;43(2):E11.

    • Search Google Scholar
    • Export Citation
  • 36

    Mummaneni PV, Bydon M, Alvi MA, et al. Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database. Neurosurg Focus. 2019;46(5):E12.

    • Search Google Scholar
    • Export Citation
  • 37

    Mummaneni PV, Bydon M, Knightly J, et al. Predictors of nonroutine discharge among patients undergoing surgery for grade I spondylolisthesis: insights from the Quality Outcomes Database. J Neurosurg Spine. 2020;32(4):523532.

    • Search Google Scholar
    • Export Citation
  • 38

    Sherrod BA, Mummaneni PV, Alvi MA, et al. Regional variance in disability and quality-of-life outcomes after surgery for grade I degenerative lumbar spondylolisthesis: a Quality Outcomes Database analysis. World Neurosurg. 2020;138:e336e344.

    • Search Google Scholar
    • Export Citation
  • 39

    McGirt MJ, Speroff T, Dittus RS, et al. The National Neurosurgery Quality and Outcomes Database (N2QOD): general overview and pilot-year project description. Neurosurg Focus. 2013;34(1):E6.

    • Search Google Scholar
    • Export Citation
  • 40

    Posner I, White AA III, Edwards WT, Hayes WC. A biomechanical analysis of the clinical stability of the lumbar and lumbosacral spine. Spine (Phila Pa 1976). 1982;7(4):374389.

    • Search Google Scholar
    • Export Citation
  • 41

    Fairbank JC, Couper J, Davies JB, O’Brien JP. The Oswestry low back pain disability questionnaire. Physiotherapy. 1980;66(8):271273.

    • Search Google Scholar
    • Export Citation
  • 42

    Jensen MP, Turner JA, Romano JM. What is the maximum number of levels needed in pain intensity measurement?. Pain. 1994;58(3):387392.

    • Search Google Scholar
    • Export Citation
  • 43

    EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199208.

  • 44

    Daltroy LH, Cats-Baril WL, Katz JN, et al. The North American Spine Society Lumbar Spine Outcome Assessment Instrument: reliability and validity tests. Spine (Phila Pa 1976). 1996;21(6):741749.

    • Search Google Scholar
    • Export Citation
  • 45

    Ohtori S, Inoue G, Orita S, et al. Teriparatide accelerates lumbar posterolateral fusion in women with postmenopausal osteoporosis: prospective study. Spine (Phila Pa 1976). 2012;37(23):E1464E1468.

    • Search Google Scholar
    • Export Citation
  • 46

    Cho PG, Ji GY, Shin DA, et al. An effect comparison of teriparatide and bisphosphonate on posterior lumbar interbody fusion in patients with osteoporosis: a prospective cohort study and preliminary data. Eur Spine J. 2017;26(3):691697.

    • Search Google Scholar
    • Export Citation
  • 47

    Ebata S, Takahashi J, Hasegawa T, et al. Role of weekly teriparatide administration in osseous union enhancement within six months after posterior or transforaminal lumbar interbody fusion for osteoporosis-associated lumbar degenerative disorders: a multicenter, prospective randomized study. J Bone Joint Surg Am. 2017;99(5):365372.

    • Search Google Scholar
    • Export Citation
  • 48

    Chandra Vemula VR, Prasad BC, Jagadeesh MA, et al. Minimally invasive transforaminal lumbar interbody fusion using bone cement-augmented pedicle screws for lumbar spondylolisthesis in patients with osteoporosis. Case series and review of literature. Neurol India. 2018;66(1):118125.

    • Search Google Scholar
    • Export Citation
  • 49

    Liu YY, Xiao J, Yin X, et al. Clinical efficacy of bone cement-injectable cannulated pedicle screw short segment fixation for lumbar spondylolisthesis with osteoporosise. Sci Rep. 2020;10(1):3929.

    • Search Google Scholar
    • Export Citation
  • 50

    Mo GY, Guo HZ, Guo DQ, et al. Augmented pedicle trajectory applied on the osteoporotic spine with lumbar degenerative disease: mid-term outcome. J Orthop Surg Res. 2019;14(1):170.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 555 555 377
Full Text Views 118 118 69
PDF Downloads 140 140 83
EPUB Downloads 0 0 0