Can Expert Spine Panel improve outcome for symptomatic patients with grade I degenerative lumbar spondylolisthesis?

Saturday, May 4, 2024

4:46 PM – 4:51 PM CT

Location: S401ab

Presenting Author(s)

Zoher Ghogawala, MD, FAANS, FACS

Professor and Chair, Department of Neurosurgery
Lahey Hospital and Medical Center
Burlington, MA, US

Co-Author(s)

Todd J. Albert, MD

Professor of Orthopedic Surgery
Weill Cornell Medical College
New York, NY, US
Edward C. Benzel, MD

Professor of Neurosurgery
Cleveland Clinic
Gates Mills, Ohio, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD, FAANS

Professor of Neurosurgery
Mayo Clinic
Rochester, MN, US
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
AE

Art Eleanore, MPH

Research Manager
Lahey Hospital and Medical Center
Burlington, Massachusetts, United States
Asdrubal Falavigna, MD

Professor
University
Caxias Do Sul, RS, BR
Michael G. Fehlings, MD, PhD

Neurosurgeon & Professor of Neurosurgery
University of Toronto
Toronto, ON, CA
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
James S. Harrop, MD

Professor of Neurological Surgery
Jefferson Medical College
Philadelphia, Pennsylvania, United States
Roger Hartl, MD

Director of Spinal Surgery
Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine
New York, NY, US
Langston T. Holly, MD

Chief, Spine Division
UCLA Neurosurgery
Los Angeles, CA, US
Adam S. Kanter, MD

Chief of Neurosurgery
Hoag Specialty Clinic
Newport Beach, CA, US
YK

Yoshiharu Kawaguchi, MD

Professor
University, United States
SM

Subu Magge, MD

Clinical Assistant Professor of Neurosurgery
Tufts University School of Medicine
Burlington, Massachusetts, United States
Paul McCormick, MD

Professor
Columbia
New York, NY, US
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
David W. Polly, Jr., MD

Professor
University of Minnesota
Minneapolis, Minnesota, United States
Vr

Venadatum rajshekar, MD

Professor
CMC Vellore, United States
Daniel Resnick, MD (he/him/his)

Professor
University of Wisconsin
Madison, WI, US
Michael P. Steinmetz, MD

Professor and Chairman of Neurological Surgery
Cleveland Clinic Lerner College of Medicine
Chagrin Falls, OH, US
Luis M. Tumialan, MD

Professor of Neurosurgery
Barrow Brain and Spine
Paradise Valley, AZ, US
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
Robert Whitmore, MD

Associate Professor of Neurosurgery
Tufts University School of Medicine
Burlington, MA, US

Disclosure(s):

Zoher Ghogawala, MD, FAANS, FACS: NidusAI, Inc.: Ownership Interest (Ongoing)

Erica F. Bisson, MD, MPH: No financial relationships to disclose

Mohamad Bydon, MD, FAANS: No financial relationships to disclose

Domagoj Coric, MD: 3Spine: Stock Shareholder (excluding mutual funds) (Ongoing); Globus Medical: Royalty Recipient (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing); Premia Spine: Consultant (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Pressio: Stock Shareholder (excluding mutual funds) (Ongoing); Spine Wave: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing)

Asdrubal Falavigna, MD: No financial relationships to disclose

Steven D. Glassman, MD: No financial relationships to disclose

James S. Harrop, MD: Depuy Spine: Advisor (Ongoing); ethicon: Advisor (Ongoing); spiderwort: Advisor (Ongoing)

Adam S. Kanter, MD: NuVasive/Globus: Advisor (Ongoing); ZimVie: Royalty Recipient (Ongoing)

Paul McCormick, MD: No financial relationships to disclose

Praveen V. Mummaneni, MD, MBA: AO Spine: Grant/Research Support (Ongoing); BK Medical: Speaker/Honoraria (Ongoing); Brainlab: Speaker/Honoraria (Ongoing); Depuy Synthes: Consultant (Ongoing); DOD: Research Grant (Ongoing); Globus: Consultant (Ongoing); ISSG: Grant/Research Support (Ongoing); NIH: Research Grant (Ongoing); NREF: Grant/Research Support (Ongoing); Pacira: Grant/Research Support (Ongoing); PCORI: Grant/Research Support (Ongoing); SI Bone: Speaker/Honoraria (Ongoing); SLIP II: Grant/Research Support (Ongoing); Springer Publisher: Royalty Recipient (Ongoing); Thieme Publisher: Royalty Recipient (Ongoing)

Michael P. Steinmetz, MD: cerapedics: Speaker/Honoraria (Terminated, August 1, 2023); Globus Medical: Royalty Recipient (Ongoing), Speaker/Honoraria (Ongoing); Premia Spine: Speaker/Honoraria (Terminated, August 1, 2023)

Luis M. Tumialan, MD: No financial relationships to disclose

Michael Y. Wang, MD: Depuy-Synthes: Consultant (Ongoing), Royalty Recipient (Ongoing); ISD: Stock Shareholder (excluding mutual funds) (Ongoing); Kinesiometrics: Stock Shareholder (excluding mutual funds) (Ongoing); Medical Device Partners: Stock Shareholder (excluding mutual funds) (Ongoing); NuVasive: Consultant (Ongoing); Pacira Pharmaceuticals: Consultant (Ongoing); Spineology: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Introduction: There is conflicting evidence from RCTs comparing outcomes for lumbar fusion with laminectomy versus laminectomy alone for symptomatic lumbar degenerative spondylolisthesis. We present the findings of SLIP II, an RCT investigating the potential benefits of spinal expert review in optimizing patient experience and outcomes following fusion surgery for degenerative lumbar spondylolisthesis.

Methods: A prospective multi-center RCT was conducted across 14 sites. Eligible patients aged 18 years or older with symptomatic degenerative spondylolisthesis were randomly assigned to receive either an expert panel review or standard care. The expert panel review involved a comprehensive evaluation of patient images and medical history by 10-15 experienced surgeons. Decision for surgical intervention was at the discretion of the treating surgeon. Fusion outcomes were compared between cases aligning with a super-majority consensus (>80%) and cases without consensus. EQ-5D and ODI, and work status were recorded pre-operatively and post-surgery (1 and 2 years). Patient satisfaction was assessed using NASS patient satisfaction at 1 year post-op.

Results: 662 patients (mean age 65.4 years, with 60% being female) were randomized across 14 sites, with 341 receiving an expert panel review. Analysis was performed on 274 patients in whom 2-year follow-up was available. Fusion surgery was performed on 203 (74%) patients. No significant differences were observed in outcomes between decompression alone and decompression with fusion at 2 years. A super-majority (>80%) of the expert panel recommended fusion in 75 (27.4%) of cases. Super-majority fusion recommendation did not predict superior outcome using ODI or Eq5D. Super-majority vote for fusion was associated with superior patient satisfaction 84% vs. 67.6% (p=0.03).

Conclusion : The findings of this study indicate that super-majority vote in favor of fusion was associated with increased patient satisfaction and higher chance of return to work. Future investigations will focus on utilizing machine learning techniques based on super-majority consensus to identify patients who are most likely to benefit from lumbar fusion for grade I spondylolisthesis.