Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis : Analysis from the Canadian Spine Outcomes and Research Network (CSORN) prospective lumbar degenerative spondylolisthesis propensity score matched study — The International Society for the Study of the Lumbar Spine
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  2. Special Poster Session 2H. DEGENERATIVE LUMBAR DISEASE
  3. Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis : Analysis from the Canadian Spine Outcomes and Research Network (CSORN) prospective lumbar degenerative spondylolisthesis propensity score matched study

Posterolateral versus posterior interbody fusion for the management of lumbar degenerative spondylolisthesis : Analysis from the Canadian Spine Outcomes and Research Network (CSORN) prospective lumbar degenerative spondylolisthesis propensity score matched study (#132)

Patrick Thornley 1 , Asra Toobaie 1 , Jennifer Urquhart 1 , Parham Rasoulinejad 1 , Chris Bailey 1 , Andrew Glennie 2 , Raja Rampersaud 3 , Neil Manson 4 , Edward Abraham 4 , Charles Fisher 5 , Raphaele Charest-Morin 5 , Scott Paquette 5 , Nicholas Gélinas-Phaneuf 6 , Ken Thomas 7 , Nicholas Dea 5 , Marcel Dvorak 5 , Brian Kwon 5 , John Street 5 , Tamir Ailon 5 , Sean Christie 8
  1. Orthopaedic Surgery, London Health Sciences Centre, London, Ontario, Canada
  2. Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
  3. Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
  4. Canada East Spine Center and Horizon Health Network, Saint John, New Brunswick, Canada
  5. Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
  6. Orthopaedic Surgery, Hopital de l'Enfant-Jesus, Quebec, Canada
  7. Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
  8. Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada

Introduction:  The benefit of interbody fusion (IF) over posterolateral fusion in the treatment of spondylolisthesis is controversial. Little evidence focuses on the treatment of degenerative spondylolisthesis. The objective of this study was to compare post-operative patient rated outcomes (PROs) of posterolateral fusion (PLF) versus IF surgery in patients with lumbar degenerative spondylolisthesis.

Methods: This is a retrospective analysis of data from a CSORN multi-centred prospective study on the assessment and management of lumbar degenerative spondylolisthesis patients. Inclusion criteria included: lumbar degenerative spondylolisthesis at one or two levels, age ≥ 18 years, IF or PLF surgery, minimum one year follow up post-surgery. A propensity-score matching was used to similar cohorts of IF and PLF patients based on baseline patient characteristics including:  sex, age, primary symptom type (radiculopathy vs. claudication back pain), BMI, SF-12 MCS, spondylolisthesis grade, disc angle (lordotic vs. kyphotic/neutral), smoking status, levels fused, back pain, and presence of neurologic deficit (motor or sensory).  PROs including NRS back pain, NRS leg pain, ODI, SF-12 MCS and PCS were compared over time using repeated measures mixed effects modeling.

 

Results:  Eight centers participated in the study. Of the 567 enrolled patients, 278 (PLF=56; IF=222) met the inclusion criteria. After propensity score matching, 48 patients were included in each group. Follow up rate was 80% at 1 year. Study participants mostly were female, had grade I spondylolisthesis in a single level, neurogenic claudication, and symptom duration greater than 2 years. At 3 and 12 months there were no significant differences in the intensity of back pain, leg pain, ODI, MCS, or PCS scores between PLF and IF groups. Operation time, blood loss, adverse events, and length of stay were equal between groups. 

Discussion:  Our study found equivalence in PROs between PLF and IF in propensity matched patients with degenerative spondylolisthesis at 12 months. Longer term follow up and focused investigation are required to determine if specific indications exist for IF in the management of degenerative spondylolisthesis.

 

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