Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Chan, Andrew K.; Bisson, Erica F.; Bydon, Mohamad; Glassman, Steven D.; Foley, Kevin T.; Potts, Eric A; Shaffrey, Christopher I.; Shaffrey, Mark E.; Coric, Domagoj; Knightly, John J; Park, Paul; Fu, Kai; Slotkin, Jonathan R.; Asher, Anthony L.; Virk, Michael S.; Kerezoudis, Panagiotis; Chotai, Silky; DiGiorgio, Anthony M; Chan, Alvin Y.; Haid, Regis W.; Mummaneni, Praveen V.

doi:10.3171/2017.10.focus17553

Cited by 32 publications

(20 citation statements)

References 29 publications

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“…However, a majority of patients receiving decompression alone surgery remained satisfied as well, suggesting that satisfaction is multifactorial and may be attributable to other patient (e.g., age, sex, comorbidities, clinical presentation), surgical (type of decompressive technique), and radiographic (degenerative status of a disc and slip progression) factors. 5,6,8,15,18,20,22,23,29,30 Of note, in the meta-analysis by Liang et al-reporting on open surgical techniques-significant relationships between the addition of fusion and ODI and of fusion and back pain were not detected. 22 However, a significant relationship was detected between the addition of fusion and leg pain.…”

Section: Discussionmentioning

confidence: 96%

“…Twelve of the high-enrolling QOD sites participate in the lumbar spondylolisthesis module/study group. 4,8,28 We queried the lumbar spondylolisthesis module from July 2014 through June 2016 for patients undergoing singlesegment, posterior-approach surgery for grade 1 lumbar spondylolisthesis. Preoperative plain radiographs (standing or dynamic) were obtained and were evaluated by sur-geons at the participating sites to confirm the diagnosis of grade 1 spondylolisthesis as defined by the Meyerding classification.…”

Section: Methodsmentioning

confidence: 99%

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A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Chan

Bisson

Bydon

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe optimal minimally invasive surgery (MIS) approach for grade 1 lumbar spondylolisthesis is not clearly elucidated. In this study, the authors compared the 24-month patient-reported outcomes (PROs) after MIS transforaminal lumbar interbody fusion (TLIF) and MIS decompression for degenerative lumbar spondylolisthesis.METHODSA total of 608 patients from 12 high-enrolling sites participating in the Quality Outcomes Database (QOD) lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis, of whom 143 underwent MIS (72 MIS TLIF [50.3%] and 71 MIS decompression [49.7%]). Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse plane MIS intervertebral body graft (MIS TLIF) or if there was a tubular decompression (MIS decompression). Parameters obtained at baseline through at least 24 months of follow-up were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back pain, NRS for leg pain, EuroQol-5D (EQ-5D) questionnaire, and North American Spine Society (NASS) satisfaction questionnaire. Multivariate models were constructed to adjust for patient characteristics, surgical variables, and baseline PRO values.RESULTSThe mean age of the MIS cohort was 67.1 ± 11.3 years (MIS TLIF 62.1 years vs MIS decompression 72.3 years) and consisted of 79 (55.2%) women (MIS TLIF 55.6% vs MIS decompression 54.9%). The proportion in each cohort reaching the 24-month follow-up did not differ significantly between the cohorts (MIS TLIF 83.3% and MIS decompression 84.5%, p = 0.85). MIS TLIF was associated with greater blood loss (mean 108.8 vs 33.0 ml, p < 0.001), longer operative time (mean 228.2 vs 101.8 minutes, p < 0.001), and longer length of hospitalization (mean 2.9 vs 0.7 days, p < 0.001). MIS TLIF was associated with a significantly lower reoperation rate (14.1% vs 1.4%, p = 0.004). Both cohorts demonstrated significant improvements in ODI, NRS back pain, NRS leg pain, and EQ-5D at 24 months (p < 0.001, all comparisons relative to baseline). In multivariate analyses, MIS TLIF—as opposed to MIS decompression alone—was associated with superior ODI change (β = −7.59, 95% CI −14.96 to −0.23; p = 0.04), NRS back pain change (β = −1.54, 95% CI −2.78 to −0.30; p = 0.02), and NASS satisfaction (OR 0.32, 95% CI 0.12–0.82; p = 0.02).CONCLUSIONSFor symptomatic, single-level degenerative spondylolisthesis, MIS TLIF was associated with a lower reoperation rate and superior outcomes for disability, back pain, and patient satisfaction compared with posterior MIS decompression alone. This finding may aid surgical decision-making when considering MIS for degenerative lumbar spondylolisthesis.

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Section: Discussionmentioning

confidence: 96%

Section: Methodsmentioning

confidence: 99%

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Chan

Bisson

Bydon

et al. 2019

Neurosurgical Focus

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“…Among these sites, 12 sites came together to initiate a focused project to assess the impact of fusion on PROs in patients undergoing surgery for grade I lumbar spondylolisthe-sis. [7][8][9][10]35 This focused group consisted of 1) sites with a study coordinator and 2) a centralized auditing mechanism to ensure data accuracy. To determine the diagnosis of grade I spondylolisthesis, surgeons at each of the participating sites evaluated preoperative standing or dynamic radiographs.…”

Section: Cohortmentioning

confidence: 99%

“…To determine the diagnosis of grade I spondylolisthesis, surgeons at each of the participating sites evaluated preoperative standing or dynamic radiographs. [7][8][9][10]35 Intraoperative variables, including laminectomy performed, fusion performed, and number of levels of fusion or laminectomy, and minimally invasive versus open surgery, were also abstracted for all eligible patients. [7][8][9][10]35 For the current article, we only included patients who underwent elective 1-or 2-level decompression or 1-level decompression and fusion for grade I spondylolisthesis, according to the Meyerding classification, 33 and who had available data for North American Spine Surgery (NASS) satisfaction after 2 years.…”

Section: Cohortmentioning

confidence: 99%

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Mummaneni

Bydon

Alvi

et al. 2019

Neurosurgical Focus

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OBJECTIVESince the enactment of the Affordable Care Act in 2010, providers and hospitals have increasingly prioritized patient-centered outcomes such as patient satisfaction in an effort to adapt the “value”-based healthcare model. In the current study, the authors queried a prospectively maintained multiinstitutional spine registry to construct a predictive model for long-term patient satisfaction among patients undergoing surgery for Meyerding grade I lumbar spondylolisthesis.METHODSThe authors queried the Quality Outcomes Database for patients undergoing surgery for grade I lumbar spondylolisthesis between July 1, 2014, and June 30, 2016. The primary outcome of interest for the current study was patient satisfaction as measured by the North American Spine Surgery patient satisfaction index, which is measured on a scale of 1–4, with 1 indicating most satisfied and 4 indicating least satisfied. In order to identify predictors of higher satisfaction, the authors fitted a multivariable proportional odds logistic regression model for ≥ 2 years of patient satisfaction after adjusting for an array of clinical and patient-specific factors. The absolute importance of each covariate in the model was computed using an importance metric defined as Wald chi-square penalized by the predictor degrees of freedom.RESULTSA total of 502 patients, out of a cohort of 608 patients (82.5%) with grade I lumbar spondylolisthesis, undergoing either 1- or 2-level decompression (22.5%, n = 113) or 1-level decompression and fusion (77.5%, n = 389), met the inclusion criteria; of these, 82.1% (n = 412) were satisfied after 2 years. On univariate analysis, satisfied patients were more likely to be employed and working (41.7%, n = 172, vs 24.4%, n = 22; overall p = 0.001), more likely to present with predominant leg pain (23.1%, n = 95, vs 11.1%, n = 10; overall p = 0.02) but more likely to present with lower Numeric Rating Scale score for leg pain (median and IQR score: 7 [5–9] vs 8 [6–9]; p = 0.05). Multivariable proportional odds logistic regression revealed that older age (OR 1.57, 95% CI 1.09–2.76; p = 0.009), preoperative active employment (OR 2.06, 95% CI 1.27–3.67; p = 0.015), and fusion surgery (OR 2.3, 95% CI 1.30–4.06; p = 0.002) were the most important predictors of achieving satisfaction with surgical outcome.CONCLUSIONSCurrent findings from a large multiinstitutional study indicate that most patients undergoing surgery for grade I lumbar spondylolisthesis achieved long-term satisfaction. Moreover, the authors found that older age, preoperative active employment, and fusion surgery are associated with higher odds of achieving satisfaction.

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“…The patients were assessed for the indication for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10). [17,18] and the complications of the procedure.. Data was analysed using the epi info statistical software.…”

Section: Methodsmentioning

confidence: 99%

Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria

Bundepuun¹

2018

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Degenerative diseases of the spine are a common presentation to the clinician, more so with an increase in the ageing population worldwide. Operative methods of treatment are employed following failure of conservative methods. Spine surgical procedures are expensive, and many different procedures are employed to treat these spinal conditions. Instrumented posterolateral fusion (PLF) is one of the options employed and has a reduced cost owing to the absence of the inter body cage used in inter body fusion techniques. The objective of this study was to assess posterolateral fusions in our center within a developing country with poor health insurance coverage as an effective treatment modality in degenerative lumbosacral spine disease, without the added cost of an interbody fusion cage. This was a retrospective study carried out in Jos, Nigeria covering a two year period from July 2015 to June 2017. Patients with degenerative spine diseases who had been on conservative methods of treatment for more than six months with no significant improvement were recruited for the study. Data was obtained from the case records of the patients the patients were assessed for the indications for the procedure, the number of levels of fusion, duration of surgery and transfusion requirement as well as outcome of procedure using the Numeric pain scale (11 point scale from 0 to 10) and the complications of the procedure. Data was analyzed using the epi info statistical software. 13 patients had Posterolateral fusion (PLF) within this period. The mean age was 61.4years ±10.7. A male female ratio of M:F 1:3.3. 8(61.5%) patients had multiple level disc degeneration and herniation, 2(15.4%) patients each had spinal canal stenosis and facet joint arthritis with instability and 1(7.7%) had degenerative spondylolisthesis. 9(69.2%) patients had 2 level fusion, 2 (15.4%) had 3 level fusion and 2(15.4%) had 1 level fusion. 6(46.2%) had a pain reduction by ≥ 8 points on the numeric pain scale, 6(46.2%) had reduction by 6-7 points and 1(7.7%) had reduction of 3-5 points. 92.6% of the patients had a pain reduction by more than 50%. Mean operative time was 203minutes, and mean transfusion requirement was 2.8 pints of blood. Complications noted were superficial surgical site infection 1 patient and dural tear 1 patient. Postero lateral fusion techniques are a safe and effective treatment modality in treating patients with degenerative lumbosacral spine disease. The non usage of the interbody fusion cage provides a cheaper alternative in posterolateral fusion and every modality to limit surgical site infection should be employed to limit increased cost from this complication.

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Women fare best following surgery for degenerative lumbar spondylolisthesis: a comparison of the most and least satisfied patients utilizing data from the Quality Outcomes Database

Cited by 32 publications

References 29 publications

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

A comparison of minimally invasive transforaminal lumbar interbody fusion and decompression alone for degenerative lumbar spondylolisthesis

Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database

Postero-Lateral Fusion (PLF) for Degenerative Diseases of the Lumbosacral Spine in Jos Nigeria

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