Clinical and Radiological Predictors of Slower and Non-Improvement Following Surgical Treatment of L4-5 Degenerative Spondylolisthesis: Preliminary Results

Sumedha Singh; Pratyush Shahi; Junho Song; Tejas Subramanian; Kyle Morse; Omri Maayan; Kasra Araghi; Nishtha Singh; Olivia Tuma; Tomoyuki Asada; Maximilian Korsun; Eric Mai; James Dowdell; Evan Sheha; Harvinder Sandhu; Todd Albert; Sheeraz Qureshi; Sravisht Iyer

doi:10.1097/BRS.0000000000005019

Clinical and Radiological Predictors of Slower and Non-Improvement Following Surgical Treatment of L4-5 Degenerative Spondylolisthesis: Preliminary Results

Spine (Phila Pa 1976). 2024 Apr 29. doi: 10.1097/BRS.0000000000005019. Online ahead of print.

Authors

Sumedha Singh¹, Pratyush Shahi¹, Junho Song¹, Tejas Subramanian^{1

2}, Kyle Morse¹, Omri Maayan^{1

2}, Kasra Araghi¹, Nishtha Singh¹, Olivia Tuma¹, Tomoyuki Asada¹, Maximilian Korsun¹, Eric Mai¹, James Dowdell¹, Evan Sheha¹, Harvinder Sandhu¹, Todd Albert¹, Sheeraz Qureshi¹, Sravisht Iyer¹

Affiliations

¹ Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
² Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, USA, Institute where the work was performed: Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.

PMID: 38679887
DOI: 10.1097/BRS.0000000000005019

Abstract

Study design: Retrospective cohort.

Objective: To identify the predictors of slower and non-improvement following surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).

Summary of background data: There is limited evidence regarding clinical and radiological predictors of slower and non-improvement following surgery for L4-5 DLS.

Methods: Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiological variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.

Results: 233 patients (37% decompression, 63% fusion) were included. At <3 months, high pelvic tilt (PT) (OR 0.92, P 0.02) and depression (OR 0.28, P 0.02) were predictors of MCID non-achievement and GRC non-betterment, respectively. Neither retained significance at >6 months and hence, were identified as predictors of slower improvement. At >6 months, low preoperative VAS leg (OR 1.26, P 0.01) and high facet orientation (OR 0.95, P 0.03) were predictors of MCID non-achievement, high L4-5 slip percentage (OR 0.86, P 0.03) and L5-S1 angular motion (OR 0.78, P 0.01) were predictors of GRC non-betterment, and high preoperative ODI (OR 0.96, P 0.04) was a predictor of PASS non-achievement.

Conclusions: High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of non-improvement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.