Prevalence of Impaired Traveling Ability and Postoperative Outcomes in Patients with Grade I Lumbar Spondylolisthesis: A Quality Outcomes Database Study

Wednesday, February 21, 2024

Presenting Author(s)

Rida Mitha, MBBS (she/her/hers)

Research Fellow
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

Co-Author(s)

Nitin Agarwal, MD (he/him/his)

Associate Professor
University of Pittsburgh Department of Neurosurgery
Pittsburgh, PA, US
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, North Carolina, United States
Oren Gottfried, MD (he/him/his)

Professor of Neurosurgery
Duke University
Durham, NC, US
Luis M. Tumialán, MD

Professor of Neurosurgery
Barrow Brain and Spine
Paradise Valley, Arizona, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, Virginia, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
Asimina Dominari, MD

Postdoctoral Research Fellow
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
Anthony L. Asher, MD (he/him/his)

Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, NY, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, NY, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US

Disclosure(s):

Asimina Dominari, MD: No financial relationships to disclose

Introduction: Lumbar spondylolisthesis associated pain can affect traveling ability. Patients often recite traveling in the back seat of a vehicle to be particularly aggravating. The benefits of surgery to improve the ability to travel are investigated.

Methods: The low-grade spondylolisthesis database of the Quality Outcomes Database was utilized. Traveling subcomponent of the Oswestry Disability Index (ODI) was evaluated, with limited traveling ability defined as an ODI Traveling score (ODITS) of ≥ 3. Improvement in traveling ability was defined as improvement of ≥ 1 point in ODITS and best response to treatment, defined as ODITS=0 among patients with baseline ODITS=5.

Results: Of 601 patients operated for Grade I lumbar spondylolisthesis, 38.4% had limited traveling ability. Dependent ambulation (OR=1.2, 95%CI:1.1-1.4, p < 0.01), age ≤ 63 years (OR=1.2, 95%CI:1.1-1.3, p < 0.01), body mass index (BMI) > 29 (OR=1.1, 95%CI:1-1.2, p < 0.01), and depression (OR=1.2, 95%CI: 1.0-1.3, p=0.01) were associated with limited baseline traveling ability. At 1 year, 67.9% patients reported improvement, specifically patients who were younger (61.9 vs. 64.7, p=0.02), underwent fusion (81.9% vs. 68.2%, p < 0.01), had higher leg (6.8 vs. 5.9, p < 0.01) and back pain (NRS) scores (6.9 vs. 6.1, p < 0.01), and ODI scores (48.9 vs. 41.2, p < 0.01). Best response to treatment was noted in 29.3% by 1 year. Improvement was sustained in 72% by 1 year, and 66.7% by 5 years. Sustained improvement at 5 years was more likely with lower leg (1.6 vs. 3.7, p < 0.01) and back pain scores (2.3 vs. 4.8, p < 0.01), ODI scores (13.7 vs. 33.5, p < 0.01), and higher EQ-5D scores (0.843 vs. 0.660, p < 0.01) at 1 year.

Conclusion : Following surgery for grade I lumbar spondylolisthesis, significant improvement in traveling ability is achieved by 1 year, and remains largely durable 5 years postoperatively.