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Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low Grade Spondylolisthesis: An Analysis from QOD

Friday, May 3, 2024

Presenting Author(s)

Mladen Djurasovic, MD (he/him/his)

Attending Surgeon
Norton Leatherman Spine Center
Louisville, KY, US
VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco

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
LC

Leah Carreon, MD, MSc

Clinical Research Director
Norton Leatherman Spine Center
Louisville, Kentucky, 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
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
RH

Regis Haid, MD

Neurosurgeon
Atlanta Brain and Spine Care, United States
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
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 E. Shaffrey, MD

Professor
University of Virginia
Charlottesville, Virginia, United States
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
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: Surgical treatment for low grade spondylolisthesis generally leads to significant improvement in health-related quality of life. Most patients experience rapid improvement in the first 3-6 months after surgery, however a minority of patients have delayed improvement. The purpose of this study is to examine factors associated with delayed improvement after surgical treatment of low grade spondylolisthesis.

Methods: Patients were identified from a prospectively enrolled multi-center registry of patients undergoing lumbar fusion surgery for spondylolisthesis. 436 patients were identified who had lumbar fusion for grade 1 spondylolisthesis, with a minimum 1 year follow up. Outcome measures were collected at 3, 6, 12 and 24 month follow-up time points, including back and leg pain numeric rating scores, Oswestry Disability Index (ODI), EuroQol-5D (EQ-5D). Patients were categorized as demonstrating delayed clinical improvement if they had not reached MCID threshold at 3 months, but did ultimately reach MCID at 12-months. Binary logistic regression analysis was used to analyze factors associated with delayed clinical improvement.

Results: Overall, 317 (72.7%) patients reached the MCID threshold at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved MCID threshold by the 3 month postop follow-up. 68 patients (15.6%) showed a delayed trajectory, and had not achieved MCID threshold at 3 months but did ultimately reach the threshold at 12-month follow-up. Factors which predicted delayed clinical improvement included pre-op ambulatory status (OR=6.09, p< 0.001), baseline back pain (OR=0.80, p=0.018), and baseline (OR=0.82, p=0.032) and 3 month leg pain (OR=1.46, p< 0.001).

Conclusion : The majority of patients undergoing lumbar decompression and fusion for low grade spondylolisthesis reach MCID threshold rapidly, within the first three months following surgery. Independent predictors of delayed clinical improvement include impaired preoperative ambulation status, high preoperative low back pain and high preoperative and 3-month leg pain.