Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Degenerative Spondylolisthesis With Predominant Back Pain Versus Predominant Leg Pain Symptoms

Aayush Kaul; Jacob C Wolf; Fatima N Anwar; Andrea M Roca; Ishan Khosla; Alexandra C Loya; Srinath S Medakkar; Kevin C Jacob; Madhav R Patel; Hanna Pawlowski; Alexander W Parsons; Nisheka N Vanjani; Michael C Prabhu; Vincent P Federico; Arash J Sayari; Gregory D Lopez; Kern Singh

doi:10.1097/BSD.0000000000001705

Comparing Patient-Reported Outcomes in Patients Undergoing Lumbar Fusion for Degenerative Spondylolisthesis With Predominant Back Pain Versus Predominant Leg Pain Symptoms

Clin Spine Surg. 2024 Dec 23. doi: 10.1097/BSD.0000000000001705. Online ahead of print.

Authors

Aayush Kaul¹, Jacob C Wolf¹, Fatima N Anwar², Andrea M Roca², Ishan Khosla², Alexandra C Loya², Srinath S Medakkar², Kevin C Jacob², Madhav R Patel², Hanna Pawlowski², Alexander W Parsons², Nisheka N Vanjani², Michael C Prabhu², Vincent P Federico², Arash J Sayari², Gregory D Lopez², Kern Singh²

Affiliations

¹ Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago.
² Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.

PMID: 39714027
DOI: 10.1097/BSD.0000000000001705

Abstract

Study design: Retrospective review.

Objective: This study aims to compare postoperative patient-reported outcome measures (PROMs) in predominant back pain (PBP) versus predominant leg pain (PLP) patients following lumbar fusion for degenerative spondylolisthesis (DS).

Summary of background data: Prior studies comparing PROMs in patients undergoing lumbar fusion with PBP versus PLP symptoms have included heterogeneous spinal pathology and restricted analysis to posterior fusion techniques.

Methods: Demographics, perioperative characteristics, complications, and PROMs from a retrospective single-surgeon database were collected for primary, elective, and single-level lumbar fusion for DS. Preoperative/postoperative PROMs included visual analog scale (VAS)-back/leg pain (VAS-BP/VAS-LP), Oswestry disability index (ODI), 12-Item Short Form Physical and Mental Composite Score (SF-12 PCS/MCS), and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF). Preoperative VAS-BP>VAS-LP established the PBP cohort and VAS-LP>VAS-BP established the PLP cohort. The average follow-up was 23.4±2.8 months. Improvement in PROMs (ΔPROM) at 6 weeks (ΔPROM-6W) and final follow-up (ΔPROM-FF) were calculated. χ2 and the Student t test analyzed categorical and continuous variables, respectively. Postoperative PROMs, ΔPROMs, and MCID achievement rates were compared between groups with multivariate linear or logistic regression.

Results: In total, 166 patients were selected with 108 in the PBP cohort. Both cohorts saw improvements in all PROM scores over time. The PBP cohort reported significantly greater ΔPROM-6W and ΔPROM-FF for VAS-BP (P<0.003). The PLP cohort reported greater ΔPROM-6W and ΔPROM-FF for VAS-LP and ΔPROM-FF for SF-12 PCS (P<0.014). MCID achievement rates for VAS-BP were higher in the PBP cohort, and VAS-LP MCID achievement rates were higher in the PLP cohort (P<0.015).

Conclusion: Regardless of predominant pain location, patients-reported improvements in all PROs at the final follow-up. Patients with PLP-reported greater improvement in leg pain and physical function and patients with PBP-reported greater back pain improvement.