PMID- 33862593
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240521
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 35
IP  - 1
DP  - 2021 Apr 16
TI  - Patient-reported outcome improvements at 24-month follow-up after fusion added to 
      decompression for grade I degenerative lumbar spondylolisthesis: a multicenter 
      study using the Quality Outcomes Database.
PG  - 42-51
LID - 10.3171/2020.9.SPINE201082 [doi]
AB  - OBJECTIVE: The ideal surgical management of grade I lumbar spondylolisthesis has 
      not been determined despite extensive prior investigations. In this cohort study, 
      the authors used data from the large, multicenter, prospectively collected 
      Quality Outcomes Database to bridge the gap between the findings in previous 
      randomized trials and those in a more heterogeneous population treated in a 
      typical practice. The objective was to assess the difference in patient-reported 
      outcomes among patients undergoing decompression alone or decompression plus 
      fusion. METHODS: The primary outcome measure was change in 24-month Oswestry 
      Disability Index (ODI) scores. The minimal clinically important difference (MCID) 
      in ODI score change and 30% change in ODI score at 24 months were also evaluated. 
      After adjusting for patient-specific and clinical factors, multivariable linear 
      and logistic regressions were employed to evaluate the impact of fusion on 
      outcomes. To account for differences in age, sex, body mass index, and baseline 
      listhesis, a sensitivity analysis was performed using propensity score analysis 
      to match patients undergoing decompression only with those undergoing 
      decompression and fusion. RESULTS: In total, 608 patients who had grade I lumbar 
      spondylolisthesis were identified (85.5% with at least 24 months of follow-up); 
      140 (23.0%) underwent decompression alone and 468 (77.0%) underwent decompression 
      and fusion. The 24-month change in ODI score was significantly greater in the 
      fusion plus decompression group than in the decompression-only group (-25.8 +/- 
      20.0 vs -15.2 +/- 19.8, p < 0.001). Fusion remained independently associated with 
      24-month ODI score change (B = -7.05, 95% CI -10.70 to -3.39, p </= 0.001) in 
      multivariable regression analysis, as well as with achieving the MCID for the ODI 
      score (OR 1.767, 95% CI 1.058-2.944, p = 0.029) and 30% change in ODI score (OR 
      2.371, 95% CI 1.286-4.371, p = 0.005). Propensity score analysis resulted in 94 
      patients in the decompression-only group matched 1 to 1 with 94 patients in the 
      fusion group. The addition of fusion to decompression remained a significant 
      predictor of 24-month change in the ODI score (B = 2.796, 95% CI 2.228-13.275, p 
      = 0.006) and of achieving the 24-month MCID ODI score (OR 2.898, 95% CI 
      1.214-6.914, p = 0.016) and 24-month 30% change in ODI score (OR 2.300, 95% CI 
      1.014-5.216, p = 0.046). CONCLUSIONS: These results suggest that decompression 
      plus fusion in patients with grade I lumbar spondylolisthesis may be associated 
      with superior outcomes at 24 months compared with decompression alone, both in 
      reduction of disability and in achieving clinically meaningful improvement. 
      Longer-term follow-up is warranted to assess whether this effect is sustained.
FAU - Bisson, Erica F
AU  - Bisson EF
AD  - 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 
      Salt Lake City, Utah.
FAU - Guan, Jian
AU  - Guan J
AD  - 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 
      Salt Lake City, Utah.
FAU - Bydon, Mohamad
AU  - Bydon M
AD  - 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
FAU - Alvi, Mohammed A
AU  - Alvi MA
AD  - 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
FAU - Goyal, Anshit
AU  - Goyal A
AD  - 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
FAU - Glassman, Steven D
AU  - Glassman SD
AD  - 3Norton Leatherman Spine Center, Louisville, Kentucky.
FAU - Foley, Kevin T
AU  - Foley KT
AD  - 4Department of Neurosurgery, University of Tennessee, Semmes-Murphey Neurologic 
      and Spine Institute, Memphis, Tennessee.
FAU - Potts, Eric A
AU  - Potts EA
AD  - 5Department of Neurological Surgery, Indiana University, Goodman Campbell Brain 
      and Spine, Indianapolis, Indiana.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - 6Departments of Neurosurgery and Orthopaedic Surgery, Duke University, Durham, 
      North Carolina.
FAU - Shaffrey, Mark E
AU  - Shaffrey ME
AD  - 7Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
FAU - Coric, Domagoj
AU  - Coric D
AD  - 8Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & 
      Spine Associates, Charlotte, North Carolina.
FAU - Knightly, John J
AU  - Knightly JJ
AD  - 9Atlantic Neurosurgical Specialists, Morristown, New Jersey.
FAU - Park, Paul
AU  - Park P
AD  - 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
FAU - Wang, Michael Y
AU  - Wang MY
AD  - 11Department of Neurological Surgery, University of Miami, Florida.
FAU - Fu, Kai-Ming
AU  - Fu KM
AD  - 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New 
      York.
FAU - Slotkin, Jonathan R
AU  - Slotkin JR
AD  - 13Geisinger Health, Danville, Pennsylvania.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - 8Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & 
      Spine Associates, Charlotte, North Carolina.
FAU - Virk, Michael S
AU  - Virk MS
AD  - 12Department of Neurological Surgery, Weill Cornell Medical Center, New York, New 
      York.
FAU - Yew, Andrew Y
AU  - Yew AY
AD  - 14Lahey Clinic, Burlington, Massachusetts.
FAU - Haid, Regis W
AU  - Haid RW
AD  - 15Atlanta Brain and Spine Care, Atlanta, Georgia; and.
FAU - Chan, Andrew K
AU  - Chan AK
AD  - 16Department of Neurological Surgery, University of California, San Francisco, 
      California.
FAU - Mummaneni, Praveen V
AU  - Mummaneni PV
AD  - 16Department of Neurological Surgery, University of California, San Francisco, 
      California.
LA  - eng
PT  - Journal Article
DEP - 20210416
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
OTO - NOTNLM
OT  - arthrodesis
OT  - decompression
OT  - degenerative
OT  - fusion
OT  - laminectomy
OT  - lumbar spine
OT  - spine surgery
OT  - spondylolisthesis
EDAT- 2021/04/17 06:00
MHDA- 2021/04/17 06:01
CRDT- 2021/04/16 20:30
PHST- 2020/06/15 00:00 [received]
PHST- 2020/09/28 00:00 [accepted]
PHST- 2021/04/17 06:01 [medline]
PHST- 2021/04/17 06:00 [pubmed]
PHST- 2021/04/16 20:30 [entrez]
AID - 10.3171/2020.9.SPINE201082 [doi]
PST - epublish
SO  - J Neurosurg Spine. 2021 Apr 16;35(1):42-51. doi: 10.3171/2020.9.SPINE201082.