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J Neurosurg Spine. 2018 Nov 1:1-8. doi: 10.3171/2018.8.SPINE17913. [Epub ahead of print]

Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database.

Author information

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

Abstract

OBJECTIVEThe AANS launched the Quality Outcomes Database (QOD), a prospective longitudinal registry that includes demographic, clinical, and patient-reported outcome (PRO) data to measure the safety and quality of spine surgery. Registry data offer "real-world" insights into the utility of spinal fusion and decompression surgery for lumbar spondylolisthesis. Using the QOD, the authors compared the initial 12-month outcome data for patients undergoing fusion and those undergoing laminectomy alone for grade 1 degenerative lumbar spondylolisthesis.METHODSData from 12 top enrolling sites were analyzed and 426 patients undergoing elective single-level spine surgery for degenerative grade 1 lumbar spondylolisthesis were found. Baseline, 3-month, and 12-month follow-up data were collected and compared, including baseline clinical characteristics, readmission rates, reoperation rates, and PROs. The PROs included Oswestry Disability Index (ODI), back and leg pain numeric rating scale (NRS) scores, and EuroQol-5 Dimensions health survey (EQ-5D) results.RESULTSA total of 342 (80.3%) patients underwent fusion, with the remaining 84 (19.7%) undergoing decompression alone. The fusion cohort was younger (60.7 vs 69.9 years, p < 0.001), had a higher mean body mass index (31.0 vs 28.4, p < 0.001), and had a greater proportion of patients with back pain as a major component of their initial presentation (88.0% vs 60.7%, p < 0.001). There were no differences in 12-month reoperation rate (4.4% vs 6.0%, p = 0.93) and 3-month readmission rates (3.5% vs 1.2%, p = 0.45). At 12 months, both cohorts improved significantly with regard to ODI, NRS back and leg pain, and EQ-5D (p < 0.001, all comparisons). In adjusted analysis, fusion procedures were associated with superior 12-month ODI (OR 0.01, 95% CI 0.0001-0.74; p = 0.04).CONCLUSIONSSurgery for grade 1 lumbar spondylolisthesis-regardless of treatment strategy-was associated with significant improvements in disability, back and leg pain, and quality of life at 12 months. When adjusting for covariates, fusion surgery was associated with superior ODI at 12 months. Although fusion procedures were associated with a lower rate of reoperation, there was no statistically significant difference at 12 months. Further study must be undertaken to assess the durability of either surgical strategy in longer-term follow-up.

KEYWORDS:

BMI = body mass index; EQ-5D = EuroQol–5 Dimensions health survey; MCID = minimum clinically important difference; MIS = minimally invasive surgery; NRS = numeric rating scale; ODI = Oswestry Disability Index; PRO = patient-reported outcome; QOD = Quality Outcomes Database; Quality Outcomes Database; SLIP = Spinal Laminectomy versus Instrumented Pedicle Screw; SPORT = Spine Patient Outcomes Research Trial; fusion; laminectomy; lumbar; spondylolisthesis

PMID:
30544348
DOI:
10.3171/2018.8.SPINE17913

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