PMID- 32732571 OWN - NLM STAT- MEDLINE DCOM- 20210511 LR - 20240229 IS - 1528-1132 (Electronic) IS - 0009-921X (Print) IS - 0009-921X (Linking) VI - 478 IP - 8 DP - 2020 Aug TI - What Are the Patient-reported Outcomes, Complications, and Radiographic Results of Lumbar Fusion for Degenerative Spondylolisthesis in Patients Younger Than 50 Years? PG - 1880-1888 LID - 10.1097/CORR.0000000000001252 [doi] AB - BACKGROUND: The number of young patients with degenerative lumbar spondylosis is expected to increase, and with it, the number of younger patients seeking surgical treatment is likely to rise. The goals of young patients with degenerative spondylolisthesis may differ from those of older patients, but little is known about the levels of pain and function, complication rates, or radiographic union that young patients achieve after interbody fusion. QUESTIONS/PURPOSES: (1) How likely were patients younger than 50 years to achieve a minimal clinically important difference (MCID) in improvement on any of several validated patient-reported outcomes scores after transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a minimum of 2 years after surgery? (2) What proportion developed complications or underwent reoperations? (3) What proportion achieved radiographic fusion or developed adjacent-segment degeneration? METHODS: Longitudinally maintained institutional registry data of patients undergoing primary, single-level, transforaminal lumbar interbody fusion for degenerative spondylolisthesis at a single institution from 2006 to 2013 were studied in this retrospective case series. Of the 96 patients who met inclusion criteria, 14% (13 of 96) were missing follow-up data, leaving 83 patients younger than 50 years with complete clinical and radiological data at a minimum of 2 years (97%, 93 of 96 had sufficient data to assess complications and radiographic fusion). The mean age of the cohort was 44 +/- 7 years. Radiological parameters for each patient with spondylolisthesis were recorded. Clinical outcomes such as the numeric rating scale for back pain and leg pain, Oswestry Disability Index (ODI) and SF-36 were assessed preoperatively and postoperatively at 1, 3, 6 months and 2 years. The proportion of patients who had an improvement greater than the MCID of each outcome instrument was then calculated. The occurrence of any medical, surgical or wound complications, and reoperations for any reason were recorded. Radiographic fusion using Bridwell grading and adjacent-segment degeneration were assessed by an independent observer not involved in clinical care. The mean follow-up was 5 +/- 3 years. RESULTS: The proportions of patients younger than 50 years who achieved the MCID for the various patient-reported outcomes were 82% (68 of 83) for leg pain, 75% (62 of 83) for back pain, 87% (72 of 83) for ODI and 71% (59 of 83) for SF-36 physical component summary at 2 years. Two perioperative complications occurred, and two reoperations were performed for implant-related complications. A total of 85% (79 of 93) of young patients achieved stable fusion, 8% (seven of 93) had radiologic adjacent-segment degeneration, and one patient underwent a revision procedure. CONCLUSIONS: Young patients with lumbar degenerative spondylolisthesis commonly, but do not always, experience clinically meaningful gains in pain relief, function, and quality of life after transforaminal lumbar interbody fusion. A low risk of complications, reoperations, nonunion and adjacent-segment degeneration were also noted in this population. LEVEL OF EVIDENCE: Level III, therapeutic study. FAU - Goh, Graham S AU - Goh GS AD - G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. FAU - Tay, You Wei Adriel AU - Tay YWA AD - G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. FAU - Yue, Wai-Mun AU - Yue WM AD - W.-M. Yue, The Orthopaedic Centre, Mount Elizabeth Medical Centre, Singapore. FAU - Guo, Chang-Ming AU - Guo CM AD - G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. FAU - Tan, Seang-Beng AU - Tan SB AD - S.-B. Tan, Orthopaedic and Spine Clinic, Mount Elizabeth Medical Centre, Singapore. FAU - Chen, John Li-Tat AU - Chen JL AD - G. S. Goh, Y. W. A. Tay, C. M. Guo, J. L-T. Chen, Department of Orthopaedic Surgery, Singapore General Hospital, Singapore. LA - eng PT - Journal Article PL - United States TA - Clin Orthop Relat Res JT - Clinical orthopaedics and related research JID - 0075674 SB - IM CIN - Clin Orthop Relat Res. 2020 Aug;478(8):1889-1891. PMID: 32732572 MH - Adult MH - Female MH - Humans MH - Lumbar Vertebrae/diagnostic imaging/*surgery MH - Male MH - Middle Aged MH - Patient Reported Outcome Measures MH - Postoperative Complications/etiology MH - Quality of Life MH - Radiography MH - Spinal Fusion/adverse effects/*methods MH - Spondylolisthesis/diagnostic imaging/*surgery MH - Treatment Outcome PMC - PMC7371040 COIS- Each author certifies that neither he, nor any member of his immediate family, has funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research(R) editors and board members are on file with the publication and can be viewed on request. EDAT- 2020/08/01 06:00 MHDA- 2021/05/12 06:00 PMCR- 2021/08/01 CRDT- 2020/08/01 06:00 PHST- 2020/08/01 06:00 [entrez] PHST- 2020/08/01 06:00 [pubmed] PHST- 2021/05/12 06:00 [medline] PHST- 2021/08/01 00:00 [pmc-release] AID - 00003086-202008000-00031 [pii] AID - CORR-D-19-01517 [pii] AID - 10.1097/CORR.0000000000001252 [doi] PST - ppublish SO - Clin Orthop Relat Res. 2020 Aug;478(8):1880-1888. doi: 10.1097/CORR.0000000000001252.