To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?

• Published in: European spine journal Vol. 21; no. 2; pp. 268 - 275
• Main Authors: Kleinstueck, F. S., Fekete, T. F., Mannion, A. F., Grob, D., Porchet, F., Mutter, U., Jeszenszky, D.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.02.2012; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Back Pain - etiology; Decompression, Surgical - adverse effects; Female; Humans; Intervertebral Disc Degeneration - complications; Intervertebral Disc Degeneration - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Neurosurgery; Original; Original Article; Spinal Fusion - adverse effects; Spondylolisthesis - complications; Spondylolisthesis - surgery; Surgical Orthopedics; Treatment Outcome; Leg pain; Back pain; Decompression; Degenerative spondylolisthesis; Fusion
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-011-1896-1

Introduction Clinical symptoms in lumbar degenerative spondylolisthesis (LDS) vary from predominantly radiating pain to severe mechanical low back pain. We examined whether the outcome of surgery for LDS varied depending on the predominant baseline symptom and the treatment administered [decompression with fusion (D&F) or decompression alone (D)]. Methods 213 consecutive patients (69 ± 9 years; 155f, 58 m) participated. Inclusion criteria were LDS, maximum three affected levels, no previous surgery at the affected level, and D ( N  = 56) or D&F ( N  = 157) as the operative procedure. Pre-op and at 12 months’ follow-up (FU), patients completed the multidimensional Core Outcome Measures Index (COMI) including 0–10 leg-pain (LP) and LBP scales. At 12 months’ FU, patients rated global outcome which was then dichotomised into “good” and “poor”. Results Pre-operatively, LBP and COMI scores were significantly worse ( p  < 0.05) in the D&F group than in the D group. The improvement in COMI at 12 months’ FU was significantly greater for D&F than for D ( p  < 0.001) and was not influenced by the patient’s declared “main problem” at baseline (back pain, leg pain, or neurological disturbances) ( p  > 0.05). There was a higher proportion ( p  = 0.01) of “good” outcomes at 12 months’ FU in D&F (86%) than in D (70%). Multiple regression analysis, controlling for possible confounders, revealed treatment group to be the only significant predictor of outcome (adding fusion = better outcome). Discussion Our study indicated that LDS patients showed better patient - based outcome with instrumented fusion and decompression than with decompression alone, regardless of baseline symptoms. This may be due to the fact that the underlying slippage as the cause of the stenosis is better addressed with fusion.