PMID- 38093000 OWN - NLM STAT- Publisher LR - 20231213 IS - 1432-0932 (Electronic) IS - 0940-6719 (Linking) DP - 2023 Dec 13 TI - Radiographic predictors of reaching minimal clinically important difference following lumbar fusion surgery in patients with degenerative lumbar spondylolisthesis. LID - 10.1007/s00586-023-08051-2 [doi] AB - PURPOSE: The present study aimed to (1) compare sagittal alignment between patients with degenerative lumbar spondylolisthesis (DLS) who reached or missed the minimal clinically important difference (MCID) for clinical outcomes following lumbar fusion surgery (LFS) and (2) identify radiographic predictors associated with MCID achievement in DLS patients. METHODS: A total of 91 single-level DLS patients who underwent LFS and had a minimum of 1-year follow-up were enrolled in this study. The assessed radiographic parameters included thoracic kyphosis, lumbar lordosis (LL), segmental lumbar lordosis (SLL), slip percentage, sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and sagittal vertical axis. Changes in radiographic parameters were determined by subtracting the preoperative value from the final follow-up measurement. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for both back and leg pain. MCID values were set at 10 points for ODI, 2.1 points for VAS back pain, and 2.8 points for VAS leg pain. Patients were assigned to the reached MCID (rMCID) and missed MCID (mMCID) groups based on the postoperative (post-op) recovery of clinical outcomes. RESULTS: At the last follow-up, 68.1% (62/91), 72.5% (66/91), and 76.9% (70/91) of patients reached MCID for ODI, VAS back pain, and VAS leg pain, respectively. Concerning ODI, the rMCID group exhibited higher post-op LL (47.93 degrees vs. 42.95 degrees , P = 0.044), higher post-op SLL (17.08 degrees vs. 14.41 degrees , P = 0.032), higher post-op SS (34.46 degrees vs. 30.63 degrees , P = 0.027), higher ∆LL (5.90 degrees vs. 2.44 degrees , P = 0.017), higher ∆SLL (4.63 degrees vs. - 1.03 degrees , P < 0.001), higher ∆SS (4.76 degrees vs. 1.23 degrees , P = 0.002), lower post-op PT/PI (36.95% vs. 42.01%, P = 0.049), lower ∆PT (- 3.71 degrees vs. 1.05 degrees , P < 0.001), lower ∆PT/PI (- 7.45% vs. 1.97%, P < 0.001), and lower ∆PI-LL (- 5.43 degrees vs. - 3.71 degrees , P = 0.011) than the mMCID group. Regarding VAS back pain, the rMCID group showed higher post-op SLL (17.06 degrees vs. 14.05 degrees , P = 0.021), higher post-op SS (34.34 degrees vs. 30.33 degrees , P = 0.027), higher ∆SLL (3.93 degrees vs. - 0.09 degrees , P < 0.001), and lower ∆PT (- 2.91 degrees vs. - 0.30 degrees , P = 0.039) than the mMCID group. For VAS leg pain, higher ∆SLL (3.55 degrees vs. 0.41 degrees , P = 0.003) was observed in the rMCID group than in the mMCID group. Multivariate logistic regression analysis revealed that higher ∆SLL, higher ∆SS, and higher post-op SS were independent predictors for the achievement of MCID in patients with DLS. CONCLUSION: DLS patients who reached MCID following LFS demonstrated improved post-op spinopelvic alignment. Higher ∆SLL, higher ∆SS, and higher post-op SS were the critical parameters associated with MCID achievement in patients with DLS. CI - (c) 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Wang, Dongfan AU - Wang D AUID- ORCID: 0000-0003-2869-3809 AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. FAU - Chen, Xiaolong AU - Chen X AUID- ORCID: 0000-0002-8128-0969 AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. FAU - Han, Di AU - Han D AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. FAU - Wang, Wei AU - Wang W AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. FAU - Kong, Chao AU - Kong C AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. FAU - Lu, Shibao AU - Lu S AUID- ORCID: 0000-0001-7052-7041 AD - Department of Orthopedics, Xuanwu Hospital of Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, 100053, China. shibaolu@xwh.ccmu.edu.cn. AD - National Center for Clinical Research on Geriatric Diseases, No.45 Changchun Street, Xicheng District, Beijing, China. shibaolu@xwh.ccmu.edu.cn. LA - eng GR - DFL20190802/Beijing Hospitals Authority Ascent Plan/ GR - XMLX202116/Beijing Hospitals Authority Clinical Medicine Development of special funding support/ PT - Journal Article DEP - 20231213 PL - Germany TA - Eur Spine J JT - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JID - 9301980 SB - IM OTO - NOTNLM OT - Fusion surgery OT - Lumbar spine OT - Minimal clinically important difference OT - Spinopelvic sagittal alignment OT - Spondylolisthesis EDAT- 2023/12/14 00:42 MHDA- 2023/12/14 00:42 CRDT- 2023/12/13 23:44 PHST- 2023/07/03 00:00 [received] PHST- 2023/11/12 00:00 [accepted] PHST- 2023/10/16 00:00 [revised] PHST- 2023/12/14 00:42 [medline] PHST- 2023/12/14 00:42 [pubmed] PHST- 2023/12/13 23:44 [entrez] AID - 10.1007/s00586-023-08051-2 [pii] AID - 10.1007/s00586-023-08051-2 [doi] PST - aheadofprint SO - Eur Spine J. 2023 Dec 13. doi: 10.1007/s00586-023-08051-2.