Extensive investigation has not ascertained the ideal surgical management of grade 1 lumbar spondylolisthesis. Using the large, multicenter, prospectively collected Quality Outcomes Database (QOD), we compared 24-month outcomes for patients undergoing decompression alone versus decompression and fusion.
Patients undergoing single-level surgery from 7/1/2014 through 6/30/2016 were identified. The primary outcome measure, 24-month Oswestry Disability Index (ODI) change, was analyzed with univariate and multivariable linear regression. EQ-5D scores, numerical rating scale (NRS) back and leg pain scores, and North American Spine Society patient satisfaction scores were also analyzed.
Of the 608 patients (85.5% with at least 24-month follow-up) who met the inclusion criteria, 140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression and fusion. The 24-month change in ODI was significantly greater in the fusion group than the decompression-only group (-25.8±20.0 vs. -15.2±19.8, p<0.001). Fusion remained independently associated with 24-month ODI change in our multivariable model (B=-7.05, 95% CI 10.70 to 3.39, p=<0.001). Patients in the fusion group were significantly more likely to reach minimal clinically important difference (MCID, 12.8 points) in ODI at 24 months (73.3% vs. 56.0%, p=<0.001), and to experience significantly greater NRS back pain improvement at 24-month follow-up ( 3.8±3.1 vs. -1.8±3.9, p<0.001). Fusion was also independently associated with achieving MCID for ODI at 24 months in our logistic regression model (OR 1.767, 95% CI 1.058-2.944, p=0.029).
The results of our study suggest that decompression plus fusion may offer superior outcomes to decompression alone in patients with grade 1 lumbar spondylolisthesis at 24 months. Longer-term follow-up is warranted to assess whether this effect is sustained.
Lumbar spondylolisthesis is a prevalent problem and a common condition treated by neurosurgeons. By examining surgical approach in a multi-center study with robust followup, our study will aid in surgical decision making in the management of these patients.
By the conclusion of this session, participants should be able to: 1) Describe the importance of surgical approach for management of grade I spondylolisthesis. 2) Discuss, in small groups, the advantages and disadvantages of fusion for the management of grade I lumbar spondylolisthesis. 3) Identify an effective treatment for grade I lumbar spondylolisthesis.