Predictors of the best outcomes following minimally invasive surgery for grade 1 degenerative lumbar spondylolisthesis

Andrew K. Chan, Erica F. Bisson, Mohamad Bydon, Steven D. Glassman, Kevin T. Foley, Christopher I. Shaffrey, Eric A. Potts, Mark E. Shaffrey, Domagoj Coric, John J. Knightly, Paul Park, Michael Y. Wang, Kai Ming Fu, Jonathan R. Slotkin, Anthony L. Asher, Michael S. Virk, Panagiotis Kerezoudis, Mohammed A. Alvi, Jian Guan, Regis W. HaidPraveen V. Mummaneni

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

BACKGROUND: The factors driving the best outcomes following minimally invasive surgery (MIS) for grade 1 degenerative lumbar spondylolisthesis are not clearly elucidated. OBJECTIVE: To investigate the factors that drive the best 24-mo patient-reported outcomes (PRO) following MIS surgery for grade 1 degenerative lumbar spondylolisthesis. METHODS: A total of 259 patients from the Quality Outcomes Database lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis with MIS techniques (188 fusions, 72.6%). Twenty-four-month follow-up PROs were collected and included the Oswestry disability index (ODI) change (ie, 24-mo minus baseline value), numeric rating scale (NRS) back pain change, NRS leg pain change, EuroQoL-5D (EQ-5D) questionnaire change, and North American Spine Society (NASS) satisfaction questionnaire. Multivariable models were constructed to identify predictors of PRO change. RESULTS: The mean age was 64.2 ± 11.5 yr and consisted of 148 (57.1%) women and 111 (42.9%) men. In multivariable analyses, employment was associated with superior postoperative ODI change (β-7.8; 95% CI [−12.9 to −2.6]; P =.003), NRS back pain change (β −1.2; 95% CI [−2.1 to −0.4]; P =.004), EQ-5D change (β 0.1; 95% CI [0.01-0.1]; P =.03), and NASS satisfaction (OR = 3.7; 95% CI [1.7-8.3]; P <.001). Increasing age was associated with superior NRS leg pain change (β −0.1; 95% CI [−0.1 to −0.01]; P =.03) and NASS satisfaction (OR = 1.05; 95% CI [1.01-1.09]; P=.02). Fusion surgeries were associated with superior ODI change (β −6.7; 95% CI [−12.7 to −0.7]; P =.03), NRS back pain change (β −1.1; 95% CI [−2.1 to −0.2]; P =.02), and NASS satisfaction (OR = 3.6; 95% CI [1.6-8.3]; P =.002). CONCLUSION: Preoperative employment and surgeries, including a fusion, were predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain improvement and satisfaction.

Original languageEnglish (US)
Pages (from-to)1130-1138
Number of pages9
JournalNeurosurgery
Volume87
Issue number6
DOIs
StatePublished - Dec 1 2020

Keywords

  • Lumbar
  • Minimally invasive
  • Patient-reported outcomes
  • Quality outcomes database
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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