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HomeSpineindex/list_12253_10Predictive Factors Affecting Surgical Outcomes in Patients With Degenerative Lumbar Spondylolisthesis

Predictive Factors Affecting Surgical Outcomes in Patients With Degenerative Lumbar Spondylolisthesis

Abstract and Introduction

Abstract

Study Design:Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial.

Objective: The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis.

Summary of Background Data: Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis.

Methods: This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups.

Results: Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis.

Conclusion: While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes.

Level of Evidence: 3

Introduction

In recent years, the effectiveness of surgery for lumbar spinal stenosis due to degenerative lumbar spondylolisthesis has been demonstrated,[1] and thus the number of operations for lumbar spinal stenosis has increased with the aging of the population.[2] In general, surgical outcomes for lumbar spinal stenosis due to degenerative lumbar spondylolisthesis are satisfactory, but some patients have poor postoperative outcomes.[3]

One of the difficulties with the current treatment of degenerative lumbar spondylolisthesis is the inability to predict which patients will have a poor surgical outcome. To date, the known factors that contribute to poor postoperative outcomes in lumbar spinal stenosis include smoking, preoperatively poor neurological status, and the duration of symptoms.[4,5] On the other hand, prognostic factors for a better outcome include an adequate walking capacity, weakness of fewer than 6 weeks’ duration, mononeuropathy, and the relief of preoperative symptoms with a change in posture.[5,6] However, little research has been conducted regarding factors that contribute to poor prognosis after surgery in patients with degenerative lumbar spondylolisthesis.[7,8] Furthermore, there are few randomized controlled trials (RCTs) with high levels of evidence regarding the addition of instrumentation for degenerative lumbar spondylolisthesis, and the results of these RCTs have not always been consistent.[9–11] Part of this confusion may be due to a lack of consensus regarding which parameters define abnormal intervertebral instability in patients with degenerative spondylolisthesis.[12] Accordingly, it can be assumed that fixation is performed in cases that do not require fixation and not performed in cases that do, and these factors may contribute to poor surgical outcomes.

We hypothesized that a detailed analysis of the results of our previous prospective study[11] would allow us to identify factors that contribute to poor postoperative outcomes and define clinically significant abnormal instabilities in degenerative lumbar spondylolisthesis. The purpose of this study was to identify preoperative radiographic parameters that predict poor postoperative outcomes and define clinically significant abnormal instabilities in degenerative lumbar spondylolisthesis.

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