(PS1) Stewart Dunsker Award for Best Clinical Spine Abstract (2023 Award Winner): Long-term Outcomes Following Decompression with or Without Fusion for Grade 1 Degenerative Lumbar Spondylolisthesis: 5-year Results from the Quality Outcomes Database (QOD)
Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery University of California, San Francisco San Francisco, California, United States
Disclosure(s):
Praveen Mummaneni, MD, MBA: Alan and Jacqueline Stuart Spine Outcomes Center: Grant/Research Support (Ongoing); AO spine: Grant/Research Support (Ongoing); BK Medical: Speaker/Honoraria (Ongoing); Brainlab: Speaker/Honoraria (Ongoing); Depuy Spine: Consultant (Ongoing), Royalty Recipient (Ongoing); Globus: Consultant (Ongoing); ISSG: Grant/Research Support (Ongoing); NIH: Grant/Research Support (Ongoing); NREF: Grant/Research Support (Ongoing); NuVasive: Consultant (Ongoing); PCORI: Grant/Research Support (Ongoing); Spinicity/ISD: Stock Shareholder (excluding mutual funds) (Ongoing); Springer Publishers: Royalty Recipient (Ongoing); Stryker: Consultant (Terminated); Thieme Publishers: Royalty Recipient (Ongoing)
Introduction: When comparing decompression alone versus decompression with fusion for degenerative lumbar spondylolisthesis, long-term outcomes are unclear. Here, we compare the 5-year outcomes for decompression alone and decompression with fusion for Meyerding grade 1 degenerative lumbar spondylolisthesis using the Quality Outcomes Database (QOD).
Methods: We conducted a retrospective analysis of prospectively-collected data from the QOD Spondylolisthesis Module. Patients were enrolled who received single-segment surgery for Meyerding grade 1 degenerative lumbar spondylolisthesis. Five-year clinical outcomes—Oswestry Disability Index (ODI), reaching ODI minimum clinically important difference (MCID) (defined as an ODI improvement of 12.8), Numeric Rating Scale (NRS) Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), EQ-5D, NASS Satisfaction, and cumulative reoperation rate—were compared for patients receiving decompression alone versus decompression with fusion. Multivariable analyses were conducted, adjusting for variables reaching p< 0.20 on univariate comparisons.
Results: Overall, 608 patients were enrolled: 140 decompression alone (23.0%) and 468 (77.0%) decompression with fusion. The 5-year follow-up rate was 73.2%. Both approaches were associated with mean improvements in all measured clinical outcomes compared to baseline (p < 0.001 for all). In multivariable analyses, fusion was associated with a higher odds of reaching ODI MCID (OR=1.9, 95%CI{1.2-3.1}, p=0.01), lower NRS-LP (B=-0.7, 95%CI{-1.3- -0.1}, p=0.01), and higher NASS satisfaction (OR=1.9, 95%CI{1.2-3.0}, p=0.01). Fusion was associated with similar NRS-BP (B=-0.3, 95%CI{-0.8-0.3}, p=0.36), ODI (B=-2.5, 95%CI{-6.2-1.2}, p=0.18), and EQ-5D (B=0.02, 95%CI{-0.02-0.06}, p=0.27) compared to decompression alone. The difference in 5-year cumulative reoperation rates was not statistically significant (decompression alone: 14.3% vs. fusion: 10.7%, p=0.24).
Conclusion : In a long-term, 5-year comparison of outcomes, the addition of fusion to decompression was associated with superior outcomes for leg pain and satisfaction and nearly twice the odds of achieving ODI MCID. Both procedures performed similarly for back pain, quality of life, and reoperation.
