Improvement in Patient-Reported Outcomes Among the Elderly after Surgery for Grade II Lumbar Spondylolisthesis: A 2-year Quality Outcomes Database Study

Friday, May 3, 2024

Presenting Author(s)

KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US

Co-Author(s)

Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

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

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
Oren Gottfried, MD (he/him/his)

Professor of Neurosurgery
Duke University
Durham, NC, US
SJ

Sarah Johnson, n/a

Medical Student
Johns Hopkins
Chattanooga, Tennessee, United States

Submitter(s)

VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco

Co-Author(s)

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
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
JU

Juan Uribe, MD

Vice Char of Neurosurgery
Barrow Neurological Institute
bogota, Colombia
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Introduction: With the rapid growth of our aging population and the rising prevalence of degenerative spine disorders, the effect of age on spondylolisthesis and the outcome of surgical treatment remains to be explored. This study aims to assess the effect of age on patient-reported outcomes (PROs) after surgical treatment for grade II spondylolisthesis.

Methods: This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients who underwent arthrodesis for grade II lumbar spondylolisthesis were included. Baseline characteristics and comorbidities were recorded. Pre-operative and 3-, 12-, and 24-month patient reported outcomes (PROs) including NRS Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scales along with post-operative patient satisfaction using the North American Spine Society (NASS) index were evaluated.

Results: Out of 400 patients with grade II spondylolisthesis, 390 patients who underwent fusion were categorized into two groups: < 60 years (n=155) and ≥60 years (n=235). Older patients had a lower body mass index (p < 0.01), higher rates of diabetes (p < 0.01) and osteoarthritis (p < 0.01). There were no baseline differences in PROs (ODI, EQ-5D, NRS leg pain, and back pain) among age categories (p>0.05 for all). Older patients had a significantly higher number of levels fused (p < 0.01), and greater rates of non-routine discharge (p < 0.01). No significant differences were found between age groups for post-operative complications, readmissions, or reoperations. Regardless of age, significant improvements were seen for all patients at 2-year follow-up, with most patients meeting minimal clinically important differences (MCIDs) in PROs and >87% overall satisfaction rates.

Conclusion : Most patients over age 60 undergoing fusion for grade II lumbar spondylolisthesis achieve long-term satisfaction and MCID.