Factors Associated with Long-term Deterioration in Back Pain after Surgical Treatment for Low-Grade Lumbar Spondylolisthesis at 2 and 5 Years: An Evaluation from the QOD Spondylolisthesis Data

Wednesday, February 21, 2024

Presenting Author(s)

SA

Shawn Adams, MD

Attending Surgeon
Norton Leatherman Spine Center
Louisville, Kentucky, United States

Co-Author(s)

LC

Leah Carreon, MD, MSc

Clinical Research Director
Norton Leatherman Spine Center
Louisville, Kentucky, United States
Anthony L. Asher, MD (he/him/his)

Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Dean Chou, MD

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

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Mladen Djurasovic, MD

Attending Surgeon
Norton Leatherman Spine Center
Louisville, KY, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
JG

Jian Guan, M.D.

Surgeon
Pacific Neuroscience Institute, United States
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
PK

Panagiotis Kerezoudis, M.D.

Neurosurgical Resident
Mayo Clinic
Rochester, Minnesota, United States
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco
New Haven, Connecticut, United States
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
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, North Carolina, United States
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, Virginia, United States
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, NY, US
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Introduction: Symptomatic, low-grade spondylolisthesis is usually well treated by surgical intervention. While some patients obtain less than optimal improvement, few patients frankly deteriorate. In this analysis of surgically treated low-grade spondylolisthesis we evaluated factors associated with deterioration in back pain scores at 2 and 5 years post-op.

Methods: Patients (608) with symptomatic, low-grade, lumbar spondylolisthesis were identified from the highest enrolling sites in a prospectively enrolled, multi-center registry with 80% five year follow-up. Baseline, 24-month and 60-month data was available for 388 and 456 patients respectively. Outcome measures were compared to baseline at 2 and 5-year follow-up. Patients were categorized based on Numerical Rating Scale (NRS) back pain scores compared to baseline as greater than or equal to 0 (improved or no worse), versus less than 0 (worsened).

Results: In the 24-month group (N = 388) 289 underwent lumbar fusion, 266 improved and 23 reported worse back pain at 24 months. In 60-month group, (N = 456) 347 patients underwent fusion, 320 had improved pain scores, while 27 reported increased pain. Better baseline NRS back pain scores were associated with the deterioration group at both time points (6.91 vs 3.6 for the 24-month group and 6.92 vs 4.04 for the 60-month group). Less ODI improvement at 3 months post-op and persistent leg pain throughout were also associated with ultimate deterioration in LB pain scores.

Conclusion : Patients with better back pain scores at baseline were more likely to report frank deterioration back pain scores at 2 and 5 years. As most of these cases were fusion procedures, this emphasizes one potential risk of operating on patients with less severe symptoms. Persistent leg pain was also associated with deterioration in back pain scores.