Incidence of revision surgery and patient-reported outcomes within 5 years of the index procedure for grade 1 spondylolisthesis: an analysis from the Quality Outcomes Database spondylolisthesis data

Jacob Birlingmair; Leah Y Carreon; Mladen Djurasovic; Praveen V Mummaneni; Anthony Asher; Erica F Bisson; Mohamad Bydon; Andrew K Chan; Dean Chou; Domagoj Coric; Kevin T Foley; Kai-Ming Fu; Regis Haid; John J Knightly; Vivian P Le; Paul Park; Eric A Potts; Christopher I Shaffrey; Mark E Shaffrey; Jonathan R Slotkin; Michael S Virk; Michael Y Wang; Steven D Glassman

doi:10.3171/2024.6.SPINE24488

Incidence of revision surgery and patient-reported outcomes within 5 years of the index procedure for grade 1 spondylolisthesis: an analysis from the Quality Outcomes Database spondylolisthesis data

J Neurosurg Spine. 2024 Oct 11:1-6. doi: 10.3171/2024.6.SPINE24488. Online ahead of print.

Authors

Jacob Birlingmair¹, Leah Y Carreon¹, Mladen Djurasovic¹, Praveen V Mummaneni², Anthony Asher³, Erica F Bisson⁴, Mohamad Bydon⁵, Andrew K Chan⁶, Dean Chou⁷, Domagoj Coric³, Kevin T Foley⁸, Kai-Ming Fu⁷, Regis Haid⁹, John J Knightly¹⁰, Vivian P Le², Paul Park⁸, Eric A Potts¹¹, Christopher I Shaffrey¹², Mark E Shaffrey¹³, Jonathan R Slotkin¹⁴, Michael S Virk⁷, Michael Y Wang¹⁵, Steven D Glassman¹

Affiliations

¹ 1Norton Leatherman Spine Center, Louisville, Kentucky.
² 2Department of Neurological Surgery, University of California, San Francisco, California.
³ 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
⁴ 4Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah.
⁵ 5Department of Neurologic Surgery, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota.
⁶ 6Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
⁷ 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York.
⁸ 8Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee.
⁹ 9Department of Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia.
¹⁰ 10Department of Neurosurgery, Atlantic Neurosurgical Specialists and Altair Health, Morristown, New Jersey.
¹¹ 11Goodman Campbell Brain and Spine, Carmel, Indiana.
¹² 12Departments of Neurosurgery and Orthopedic Surgery, Duke University Hospital, Durham, North Carolina.
¹³ 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
¹⁴ 14Department of Neurosurgery, Geisinger Health, Danville, Pennsylvania; and.
¹⁵ 15Department of Neurological Surgery, University of Miami, Florida.

PMID: 39393106
DOI: 10.3171/2024.6.SPINE24488

Abstract

Objective: Some patients treated surgically for grade 1 spondylolisthesis require revision surgery. Outcomes after revision surgery are not well studied. The objective of this study was to determine how revision surgery impacts patient-reported outcomes (PROs) in patients undergoing decompression only or decompression and fusion (D+F) for grade 1 spondylolisthesis within 5 years of the index surgery.

Methods: Patients in the 12 highest Quality Outcomes Database (QOD) enrolling sites with a diagnosis of grade 1 spondylolisthesis were identified and the incidence of revision surgery between the decompression-only and D+F patients were compared. PROs were compared between cohorts requiring revision surgery versus a single index procedure.

Results: Of 608 patients enrolled, 409 had complete 5-year data available for this study. Eleven (13.3%) of 83 patients underwent revision in the decompression-only group as well as 32 (9.8%) of 326 in the D+F group. For the entire cohort, patients requiring revision had significantly worse PROs at 5 years: Oswestry Disability Index (ODI) 27.4 versus 19.4, p = 0.008; numeric rating scale for back pain (NRS-BP) 4.1 versus 3.0, p = 0.013; and NRS for leg pain (NRS-LP) 3.4 versus 2.1, p = 0.029. In the decompression-only group, the change in 5-year PROs was not impacted by revision status: ODI 31.9 versus 24.2, p = 0.287; NRS-BP 1.9 versus 2.9, p = 0.325; and NRS-LP 6.2 versus 3.7, p = 0.011. In the D+F group, the change in 5-year PROs was diminished if patients required revision: ODI 19.1 versus 29.1, p = 0.001; NRS-BP 3.0 versus 4.0, p = 0.170; and NRS-LP 2.3 versus 4.6, p = 0.001.

Conclusions: The most common reasons for reoperation within 5 years in the decompression-only group were repeat decompression and instability, whereas in the D+F group the most common reason was adjacent-segment disease. The need for revision resulted in modestly diminished benefit compared with patients with no revisions. These differences were greater in the fusion cohort compared with the decompression-only cohort. The mean PRO improvement still far exceeded minimal clinically important difference thresholds for all measures for patients who underwent a revision surgery.

Keywords: clinical outcomes; grade 1 spondylolisthesis; lumbar; revision.