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

Publication ,  Journal Article
Chan, AK; Bisson, EF; Bydon, M; Glassman, SD; Foley, KT; Potts, EA; Shaffrey, CI; Shaffrey, ME; Coric, D; Knightly, JJ; Park, P; Wang, MY ...
Published in: J Neurosurg Spine
February 1, 2019

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 (β -4.79, 95% CI -9.28 to -0.31; 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.

Duke Scholars

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 1, 2019

Volume

30

Issue

2

Start / End Page

234 / 241

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spondylolisthesis
  • Spinal Fusion
  • Quality of Life
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Lumbosacral Region
 

Citation

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Chan, A. K., Bisson, E. F., Bydon, M., Glassman, S. D., Foley, K. T., Potts, E. A., … Mummaneni, P. V. (2019). Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine, 30(2), 234–241. https://doi.org/10.3171/2018.8.SPINE17913
Chan, Andrew K., Erica F. Bisson, Mohamad Bydon, Steven D. Glassman, Kevin T. Foley, Eric A. Potts, Christopher I. Shaffrey, et al. “Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database.J Neurosurg Spine 30, no. 2 (February 1, 2019): 234–41. https://doi.org/10.3171/2018.8.SPINE17913.
Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, et al. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2019 Feb 1;30(2):234–41.
Chan, Andrew K., et al. “Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database.J Neurosurg Spine, vol. 30, no. 2, Feb. 2019, pp. 234–41. Pubmed, doi:10.3171/2018.8.SPINE17913.
Chan AK, Bisson EF, Bydon M, Glassman SD, Foley KT, Potts EA, Shaffrey CI, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu K-M, Slotkin JR, Asher AL, Virk MS, Kerezoudis P, Chotai S, DiGiorgio AM, Haid RW, Mummaneni PV. Laminectomy alone versus fusion for grade 1 lumbar spondylolisthesis in 426 patients from the prospective Quality Outcomes Database. J Neurosurg Spine. 2019 Feb 1;30(2):234–241.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 1, 2019

Volume

30

Issue

2

Start / End Page

234 / 241

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spondylolisthesis
  • Spinal Fusion
  • Quality of Life
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Lumbosacral Region