Introduction: Indications for lumbar fusion surgery for degenerative disc disease (DDD) remain controversial. However, in patients with Modic changes, moderate to severe disc space collapse, absence of significant affective distress or failure to respond to atleast 1-year of nonoperative management, lumbar fusion for DDD may be indicated. We assessed the two-year patient reported outcomes after lumbar spinal surgery between patients with DDD and those with Spondylolisthesis.
Methods: A nationwide, multi-institutional, prospective spine outcomes registry was utilized for this study. In total, 1,741 patients were included; a total of 1031 patients in the DDD cohort (Group A) were compared with 636 patients in the spondylolisthesis cohort (Group B). Patients completed the Oswestry Disability Index (ODI) questionnaire, and the Visual Analog back- and leg pain questionnaires before surgery, then at 3, 6, 12, and 24 months. One- and two-year patient reported outcomes and complication rates were compared.
Results: Both cohorts were similar at baseline, Table 1. Statistically significant improvements from baseline were observed in both cohorts in all patient reported outcome measures. Patients in Groups A(DDD) showed significant 2-year improvement from baseline in VAS for back pain, VAS for leg pain and Oswestry Disability Index, Table 2. In the propensity matched cohort analysis, a similar 2-year improvement in VAS for back pain, VAS for leg pain and Oswestry Disability Index were observed between both patient groups, Table 3.
Conclusions: Our study suggests that when indicated, lumbar arthrodesis for symptomatic DDD provides significant improvement in low back pain and functional disability and should be considered a viable treatment option for patients with medically refractory DDD related back pain. When compared to patients undergoing lumbar spine fusion for spondylolisthesis, there was no observed difference in the extent of improvement from baseline, in pain and functional disability, two-years after index spine surgery.
Patient Care: Our research shows a viable treatment option for medically refractory DDD related back pain.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the outcomes of lumbar arthrodesis for symptomatic DDD and 2) describe how lumbar arthrodesis for symptomatic DDD compares to Spondylolisthesis.