Long-term (> 10 years) clinical outcomes of instrumented posterolateral fusion for spondylolisthesis

• Published in: European spine journal Vol. 30; no. 5; pp. 1380 - 1386
• Main Authors: Lehr, A. M., Delawi, D., van Susante, J. L. C., Verschoor, N., Wolterbeek, N., Oner, F. C., Kruyt, M. C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2021; Springer Nature B.V
• Subjects: Back pain; Clinical outcomes; Cross-Sectional Studies; Graft-versus-host reaction; Humans; Leg; Lumbar Vertebrae; Medicine; Medicine & Public Health; Neurosurgery; Nonunion; Original Article; Pain; Patients; Spinal Fusion; Spondylolisthesis; Surgery; Surgical Orthopedics; Treatment Outcome; Osteogenic protein-1; Spondylolisthesis; Clinical outcome; Posterolateral spinal fusion; Long-term follow-up
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-020-06671-6

Purpose Despite the rapid increase in instrumented spinal fusions for a variety of indications, most studies focus on short-term fusion rates. Long-term clinical outcomes are still scarce and inconclusive. This study investigated clinical outcomes > 10 years after single-level instrumented posterolateral spinal fusion for lumbar degenerative or isthmic spondylolisthesis with neurological symptoms. Methods Cross-sectional long-term follow-up among the Dutch participants of an international multicenter randomized controlled trial comparing osteogenic protein-1 with autograft. Clinical outcomes were assessed using the Oswestry Disability Index (ODI), EQ-5D-3L and visual analogue scale (VAS) for leg and back pain, as well as questions on satisfaction with treatment and additional surgery. Results The follow-up rate was 73% (41 patients). At mean 11.8 (range 10.1–13.7) years after surgery, a non-significant deterioration of clinical outcomes compared to 1-year follow-up was observed. The mean ODI was 20 ± 19, mean EQ-5D-3L index score 0.784 ± 0.251 and mean VAS for leg and back pain, respectively, 34 ± 33 and 31 ± 28. Multiple regression showed that diagnosis (degenerative vs. isthmic spondylolisthesis), graft type (OP-1 vs. autograft) and 1-year fusion status (fusion vs. no fusion) were not predictive for the ODI at long-term follow-up ( p  = 0.389). Satisfaction with treatment was excellent and over 70% of the patients reported lasting improvement in back and/or leg pain. No revision surgeries for non-union were reported. Conclusion This study showed favourable clinical outcomes > 10 years after instrumented posterolateral spinal fusion and supports spondylolisthesis with neurological symptoms as indication for fusion surgery.