Study Design: Retrospective cohort.
Objective: To identify the predictors of slower and non-improvement following surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).
Summary of Background Data: There is limited evidence regarding clinical and radiological predictors of slower and non-improvement following surgery for L4-5 DLS.
Methods: Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiological variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.
Results: 233 patients (37% decompression, 63% fusion) were included. At <3 months, high pelvic tilt (PT) (OR 0.92, P 0.02) and depression (OR 0.28, P 0.02) were predictors of MCID non-achievement and GRC non-betterment, respectively. Neither retained significance at >6 months and hence, were identified as predictors of slower improvement. At >6 months, low preoperative VAS leg (OR 1.26, P 0.01) and high facet orientation (OR 0.95, P 0.03) were predictors of MCID non-achievement, high L4-5 slip percentage (OR 0.86, P 0.03) and L5-S1 angular motion (OR 0.78, P 0.01) were predictors of GRC non-betterment, and high preoperative ODI (OR 0.96, P 0.04) was a predictor of PASS non-achievement.
Conclusions: High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of non-improvement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.
Competing Interests: Financial Disclosures/Conflicts of Interest: Sheeraz A. Qureshi: Royalties: Stryker K2M, Globus Medical, Inc.; Globus Medical, Inc.: HS2, LLC; Private Investments: Tissue Differentiation Intelligence; Consulting: Stryker K2M, Globus Medical, Inc.; Speaking and/or Teaching Arrangements: AMOpportunities, Globus Medical, Inc.; Board of Directors: Society of Minimally Invasive Spine Surgery; Scientific Advisory Board/Other Office: International Society for the Advancement of Spine Surgery, Cervical Spine Research Society, Lumbar Spine Research Society, North American Spine Society, Association of Bone and Joint Surgeons, Simplify Medical, Inc., LifeLink.com Inc., Society of Minimally Invasive Spine Surgery, Minimally Invasive Spine Study Group, Spinal Simplicity, LLC, Contemporary Spine Surgery, Annals of Translational Medicine.
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