Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis

Tsukasa Kanchiku; Toshihiko Taguchi; Miho Sekiguchi; Naofumi Toda; Noboru Hosono; Morio Matsumoto; Nobuhiro Tanaka; Koji Akeda; Hiroshi Hashizume; Masahiro Kanayama; Sumihisa Orita; Daisaku Takeuchi; Mamoru Kawakami; Mitsuru Fukui; Masahiko Kanamori; Eiji Wada; So Kato; Michio Hongo; Kei Ando; Yoichi Iizuka; Shota Ikegami; Naohiro Kawamura; Masanari Takami; Yu Yamato; Shinji Takahashi; Kei Watanabe; Jun Takahashi; Shinichi Konno; Hirotaka Chikuda

doi:10.1016/j.xnsj.2023.100269

Preoperative factors affecting the two-year postoperative patient-reported outcome in single-level lumbar grade I degenerative spondylolisthesis

N Am Spine Soc J. 2023 Aug 23:16:100269. doi: 10.1016/j.xnsj.2023.100269. eCollection 2023 Dec.

Authors

Tsukasa Kanchiku^{1

2}, Toshihiko Taguchi^{1

2}, Miho Sekiguchi³, Naofumi Toda⁴, Noboru Hosono⁵, Morio Matsumoto⁶, Nobuhiro Tanaka⁷, Koji Akeda⁸, Hiroshi Hashizume⁹, Masahiro Kanayama¹⁰, Sumihisa Orita¹¹, Daisaku Takeuchi¹², Mamoru Kawakami¹³, Mitsuru Fukui¹⁴, Masahiko Kanamori¹⁵, Eiji Wada¹⁶, So Kato¹⁷, Michio Hongo¹⁸, Kei Ando¹⁹, Yoichi Iizuka²⁰, Shota Ikegami²¹, Naohiro Kawamura²², Masanari Takami⁹, Yu Yamato²³, Shinji Takahashi²⁴, Kei Watanabe²⁵, Jun Takahashi²¹, Shinichi Konno³, Hirotaka Chikuda²⁰

Affiliations

¹ Department of Spine and Spinal Cord Surgery, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda City, Yamaguchi Prefecture 756-0095, Japan.
² Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture 755-8505, Japan.
³ Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, 1 Hikariga-oka, Fukushima City, Fukushima Prefecture 960-1295, Japan.
⁴ Department of Orthopaedic Surgery, Gunma Spine Center (Harunaso Hospital), 828-1 Kamitoyooka-cho, Takasaki City, Gunma Prefecture 370-0871, Japan.
⁵ Department of Orthopaedic Surgery, Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukusima, Fukushima-ku, Osaka City, Osaka Prefecture 553-0003, Japan.
⁶ Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo Prefecture 160-8582, Japan.
⁷ Department of Orthopaedic Surgery, JR Hiroshima Hospital, 1-36 Niyonosato, Hiroshimahigasi-ku, Hiroshima Prefecture 732-0057, Japan.
⁸ Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie Prefecture 514-8507, Japan.
⁹ Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama Prefecture 641-8509, Japan.
¹⁰ The Spine Center, Hakodate Central General Hospital, 33-2 Motomachi, Hakodate City, Hokkaido Prefecture 040-8585, Japan.
¹¹ Chiba University Center for Frontier Medical Engineering, Chiba, Japan, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohara, Chuo-ku, Chiba City, Chiba Prefecture 260-8677, Japan.
¹² Department of Orthopaedic Surgery, Nasu Red-Cross Hospital, 1081-4 Nakatahara, Otahara City, Tochigi Prefecture 324-0062, Japan.
¹³ Department of Orthopaedic Surgery, Saiseikai Wakayama Hospital, 45 Junibancho, Wakayama City, Wakayama Prefecture 640-8158, Japan.
¹⁴ Laboratory of Statistics, Osaka Metropolitan University Faculty of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan.
¹⁵ Department of Human Science 1, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama City, Toyama Prefecture 930-0194, Japan.
¹⁶ Spine and Spinal Cord Center, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, Osaka City, Osaka Prefecture 543-0035, Japan.
¹⁷ Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo Prefecture 113-8655, Japan.
¹⁸ Department of Orthopaedic Surgery, Akita University Graduate School of Medicine, 44-2 Hasunuma Hiroomote, Akita City, Akita Prefecture 010-8543, Japan.
¹⁹ Department of Orthopaedic Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, 2-9 Myokencho, Syowa-ku, Nagoya City, Aichi Prefecture 466-8650, Japan.
²⁰ Department of Orthopaedic Surgery, Graduate School of Medicine, Gunma University, 3-39-15 Showacho, Maebashi City, Gunma Prefecture, 371-8511, Japan.
²¹ Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto City, Nagano Prefecture 390-8621, Japan.
²² Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo Prefecture 150-8935, Japan.
²³ Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka Prefecture 431-3192, Japan.
²⁴ Department of Orthopaedic Surgery, Osaka Metropolitan University Hospital, 1-4-3 Asahimachi, Abeno-ku, Osaka City, Osaka Prefecture 545-8585, Japan.
²⁵ Department of Orthopaedic Surgery, Niigata University Medical and Dental General Hospital, 754 Asahimachidoriichibancho, Chuo-ku, Niigata City, Niigata Prefecture 951-5820, Japan.

Abstract

Background: The choice of operative method for lumbar spinal stenosis with Meyerding grade I degenerative spondylolisthesis remains controversial. The purpose of this study was to identify the preoperative factors affecting the 2-year postoperative patient-reported outcome in Meyerding grade I degenerative spondylolisthesis.

Methods: Seventy-two consecutive patients who had minimally invasive decompression alone (D group; 28) or with fusion (DF group; 44) were enrolled. The parameters investigated were the Japanese Orthopaedic Association back pain evaluation questionnaire as patient-reported assessment, and L4 slippage (L4S), lumbar lordosis (LL), and lumbar axis sacral distance (LASD) as an index of sagittal alignment for radiological evaluation. Data collected prospectively at 2 years postoperatively were examined by statistical analysis.

Results: Sixty-two cases (D group; 25, DF group; 37) were finally evaluated. In multiple logistic regression analysis, preoperative L4S and LASD were extracted as significant preoperative factors affecting the 2-year postoperative outcome. Patients with preoperative L4S of 6 mm or more have a lower rate of improvement in lumbar spine dysfunction due to low back pain (risk ratio=0.188, p=.043). Patients with a preoperative LASD of 30 mm or more have a higher rate of improvement in lumbar dysfunction due to low back pain (risk ratio=11.48, p=.021). The results of multiple logistic analysis by operative method showed that there was a higher rate of improvement in lumbar spine dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more in DF group (risk ratio=172.028, p=.01).

Conclusions: Preoperative L4S and LASD were extracted as significant preoperative factors affecting patient-reported outcomes at 2 years postoperatively. Multiple logistic analyses by the operative method suggested that DF may be advantageous in improving lumbar dysfunction due to low back pain in patients with preoperative LASD of 30 mm or more.

Keywords: Degenerative spondylolisthesis; Fusion; Lumbar spinal stenosis; Minimally invasive decompression; Patient-reported assessment; Preoperative factors.