Pain Control Affects the Radiographic Diagnosis of Segmental Instability in Patients with Degenerative Lumbar Spondylolisthesis

Background: Diagnosing intervertebral instability is crucial for the treatment of degenerative lumbar spondylolisthesis (DLS). Disabling back pain will reduce spinal mobility which leads to an underestimate of the incidence of intervertebral instability. We hypothesized that adequate analgesia could alter the flexion/extension exam performance, and thus increase the diagnostic accuracy of segmental instability. Materials and methods: One hundred patients with low-grade DLS were prospectively enrolled in the before–after cohort study. Standing lateral flexion/extension radiographs of lumbar spines were examined and analyzed before and after intramuscular injections of 30 mg ketorolac. Results: Pain score decreased significantly after analgesic injections (p < 0.001). Dynamic slip (DS), dynamic segmental angle (DA), dynamic lumbar lordosis, and slip percentage (SP) were significantly increased after pain reduction (all p < 0.001). According to the diagnostic criteria for segmental instability (DS > 4.5mm, DA>15°, or SP >15%), there were 4%, 4%, and 0.7% of total motion segments fulfilling the criteria which markedly increased to 42%, 32%, and 16.7% after analgesia was administered. The incidence of instability also increased from 6% to 38% after analgesia. Conclusions: The diagnosis rate of intervertebral instability is commonly underestimated in the presence of low back pain. This short-term pain relief facilitates reliable functional imaging adding to the diagnosis of intervertebral instability.

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Degenerative Lumbar Spondylolisthesis with Spinal Stenosis: A Comparative Study of 5-Year Outcomes Following Decompression with Fusion and Microendoscopic Decompression

Asian Spine Journal ◽

10.4184/asj.2018.12.1.132 ◽

2018 ◽

Vol 12 (1) ◽

pp. 132-139 ◽

Cited By ~ 7

Author(s):

Takato Aihara ◽

Tomoaki Toyone ◽

Yasuaki Murata ◽

Kazuhide Inage ◽

Makoto Urushibara ◽

...

Keyword(s):

Back Pain ◽

Clinical Outcomes ◽

Japanese Orthopaedic Association ◽

Large Percentage ◽

Neutral Position ◽

Maximal Extension ◽

Surgical Methods ◽

Degenerative Lumbar Spondylolisthesis ◽

Functional Scores ◽

Lumbar Spondylolisthesis

<sec><title>Study Design</title>Retrospective review of prospectively collected outcome data.</sec><sec><title>Purpose</title>To compare 5-year outcomes following decompression with fusion (FU) and microendoscopic decompression (MED) in patients with degenerative lumbar spondylolisthesis (DLS) and to define surgical indication limitations regarding the use of MED for this condition.</sec><sec><title>Overview of Literature</title>There have been no comparative studies on mid- or long-term outcomes following FU and MED for patients with DLS.</sec><sec><title>Methods</title>Forty-one consecutive patients with DLS were surgically treated. Sixteen patients first underwent FU (FU group), and 25 then underwent MED (MED group). The 5-year clinical outcomes following the two surgical methods were compared using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire.</sec><sec><title>Results</title>The degree of improvement (DOI) for social life function was significantly greater in the MED group than in the FU group. Although not statistically significant, DOIs for the other four functional scores were also greater in the MED group than in the FU group. However, patients with a large percentage of slippage in the neutral position might experience limited improvement in low back pain, those with a large percentage of slippage at maximal extension might experience limited improvement in three functional scores, and those with a small intervertebral angle at maximal flexion might have limited improvement in three functional scores after MED for DLS. Therefore, we statistically compared the DOIs between the FU and MED groups regarding the preoperative percentage of slippage in the neutral position among patients with greater than 20% slippage, the preoperative percentage of slippage at maximal extension among patients with greater than 15% slippage, and the intervertebral angle at flexion among patients with angles lesser than −5°; however, there were no statistically significant differences between the two groups.</sec><sec><title>Conclusions</title>MED is a useful minimally invasive surgical procedure that possibly offers better clinical outcomes than FU for DLS.</sec>

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Global sagittal spinal alignment in patients with degenerative low-grade lumbar spondylolisthesis

Journal of Orthopaedic Surgery ◽

10.1177/2309499019885190 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901988519

Author(s):

Hiroto Kobayashi ◽

Kenji Endo ◽

Yasunobu Sawaji ◽

Yuji Matsuoka ◽

Hirosuke Nishimura ◽

...

Keyword(s):

Sacral Slope ◽

Low Grade ◽

Spinal Alignment ◽

Sagittal Spinal Alignment ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Lumbar Spondylolisthesis ◽

Type 3

Purpose: Global sagittal spinal alignment undergoes changes on the basis of sagittal malalignment (trunk inclined forward) in natural degenerative progression. We hypothesized that this change would associate with the disease state of the degenerative lumbar spondylolisthesis (DS). This study aimed to evaluate the global sagittal spinal alignment of low-grade DS by classifying in accordance with sagittal vertical axis (SVA). Methods: The DS group was classified into three types according to the adult spinal deformity classification: type 1, SVA < 40 mm; type 2, 40 mm ≤ SVA < 95 mm; and type 3, 95 mm ≤ SVA. Age and sagittal spinal parameters (thoracic kyphosis, lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI)) were compared among three types. Results: There were statistically significant differences in age, LL, PI, and PT among the three types. In comparison between two types, there was a statistically significant difference between type 1 and type 2 and between type 1 and type 3, but not between type 2 and type 3 in these parameters. PI tended to increase as the type increases. Furthermore, there was significant difference between types 1 and 3. Conclusion: We evaluated the features of the DS types classified by sagittal alignment. Large PI is one of the risk factors for SVA deterioration of DS. PI may be involved in the onset and progression of DS.

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Predictors of the Best Outcomes Following Minimally Invasive Surgery for Grade 1 Lumbar Spondylolisthesis

Neurosurgery ◽

10.1093/neuros/nyz310_339 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Andrew Kai-Hong Chan ◽

Erica F Bisson ◽

Mohamad Bydon ◽

Steven D Glassman ◽

Kevin T Foley ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Back Pain ◽

Minimally Invasive ◽

Invasive Surgery ◽

Rating Scale ◽

College Education ◽

Leg Pain ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis

Abstract INTRODUCTION The factors driving the best outcomes following minimally invasive surgery (MIS) for degenerative lumbar spondylolisthesis (DLS) are not clearly elucidated. This study investigates the factors that drive the best patient reported outcomes (PRO) following MIS for DLS. METHODS A total of 608 patients from the prospective Quality Outcomes Database (QOD) Lumbar Spondylolisthesis Registry underwent surgery for grade 1 DLS of whom 259 underwent surgery with MIS techniques [187 fusions (72.2%)]. Surgeries were classified as MIS if any of the following were involved: MIS laminectomy, MIS pedicle screws, MIS interbody grafts, or percutaneous screws. Outcomes were assessed at 24 mo postoperatively. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) Back Pain, NRS Leg Pain, EuroQoL-5D (EQ-5D) Questionnaire, and North American Spine Society (NASS) Satisfaction Questionnaire. Multivariate models were constructed adjusting for patient characteristics, presentation characteristics, surgical variables, socioeconomic characteristics, and baseline PRO values. RESULTS The mean age of the MIS cohort was 64.2 ± 11.5 yr [148 (57.1%) women and 111 (42.9%) men]. In multivariate analyses, aside from baseline PRO values, only 3 factors were significantly associated with multiple 24-mo PRO change scores: employment, age, and the addition of fusion to surgery. Employment was associated with superior postoperative ODI (ß-7.8; 95% CI [−12.9- −2.6]; P = .003), NRS back pain (ß-1.2; 95% CI [−2.1- −0.4]; P = 0.004), EQ-5D (ß0.1; 95% CI [0.01-0.1]; P = .03), and NASS satisfaction (OR = 0.27; 95% CI [0.12-0.58]; P < .001). Increasing age was associated with superior NRS leg pain (ß-0.1; 95% CI [minus;0.1- minus;0.01]; P = .03) and NASS satisfaction (OR = 0.95; 95% CI [0.92-0.99]; P = .02). The addition of a fusion was associated with superior ODI (ß-6.7; 95% CI [minus;12.7- minus;0.7]; P = .03), NRS back pain (ß-1.1; 95% CI [minus;2.1- minus;0.2]; P = .02), and NASS satisfaction (OR = 0.28; 95% CI [0.12-0.62]; P = .002). CONCLUSION Preoperative active employment, at least 4 yr of college education, and surgeries including a fusion were significant predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain and satisfaction.

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SURGICAL MANAGEMENT OF DEGENERATIVE LUMBAR SPONDYLOLISTHESIS: A COMPARATIVE STUDY OF OUTCOMES FOLLOWING DECOMPRESSION WITH FUSION AND MICROENDOSCOPIC DECOMPRESSION

Journal of Musculoskeletal Research ◽

10.1142/s0218957712500200 ◽

2012 ◽

Vol 15 (04) ◽

pp. 1250020 ◽

Cited By ~ 7

Author(s):

Takato Aihara ◽

Tomoaki Toyone ◽

Yasuchika Aoki ◽

Tomoyuki Ozawa ◽

Gen Inoue ◽

...

Keyword(s):

Back Pain ◽

Clinical Outcome ◽

Japanese Orthopaedic Association ◽

Neutral Position ◽

Minimally Invasive Operation ◽

Surgical Methods ◽

Degenerative Lumbar Spondylolisthesis ◽

Functional Scores ◽

Lumbar Spondylolisthesis

Fifty consecutive patients with degenerative lumbar spondylolisthesis were treated surgically. The first 17 patients (FU group) underwent decompression with fusion, the second 33 patients (MED group) underwent microendoscopic decompression (MED), and the outcomes following the two surgical methods were compared. The duration of follow-up ranged from 27 to 40 months in the FU group and from 25 to 40 months in the MED group. Clinical outcomes were evaluated with use of the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Although statistically not significant, the degrees of improvement in all five functional scores were greater in the MED group than in the FU group. There was no influence of instability before MED to the clinical outcome, and a large percentage of slipping in the neutral position could lead to inadequate improvement in low back pain after MED, but MED is a useful, minimally invasive operation and can lead to a good clinical outcome for degenerative lumbar spondylolisthesis. Considering the lower invasiveness of MED, this procedure is recommended in case of degenerative lumbar spondylolisthesis with less than 20% slipping. Posterior decompression and fusion using pedicular screws is recommended in case of degenerative lumbar spondylolisthesis with over 20% slipping.

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Correlation of return to work with patient satisfaction after surgery for lumbar spondylolisthesis: an analysis of the Quality Outcomes Database

Neurosurgical FOCUS ◽

10.3171/2020.2.focus191022 ◽

2020 ◽

Vol 48 (5) ◽

pp. E5 ◽

Cited By ~ 2

Author(s):

Anthony M. DiGiorgio ◽

Praveen V. Mummaneni ◽

Paul Park ◽

Andrew K. Chan ◽

Erica F. Bisson ◽

...

Keyword(s):

Patient Satisfaction ◽

Back Pain ◽

Return To Work ◽

Rating Scale ◽

College Education ◽

Quality Outcomes ◽

Data Set ◽

Number Of Patients ◽

Degenerative Lumbar Spondylolisthesis ◽

Lumbar Spondylolisthesis

OBJECTIVEReturn to work (RTW) and satisfaction are important outcome measures after surgery for degenerative spine disease. The authors queried the prospective Quality Outcomes Database (QOD) to determine if RTW correlated with patient satisfaction.METHODSThe QOD was queried for patients undergoing surgery for degenerative lumbar spondylolisthesis. The primary outcome of interest was correlation between RTW and patient satisfaction, as measured by the North American Spine Society patient satisfaction index (NASS). Secondarily, data on satisfied patients were analyzed to see what patient factors correlated with RTW.RESULTSOf 608 total patients in the QOD spondylolisthesis data set, there were 292 patients for whom data were available on both satisfaction and RTW status. Of these, 249 (85.3%) were satisfied with surgery (NASS score 1–2), and 224 (76.7%) did RTW after surgery. Of the 68 patients who did not RTW after surgery, 49 (72.1%) were still satisfied with surgery. Of the 224 patients who did RTW, 24 (10.7%) were unsatisfied with surgery (NASS score 3–4). There were significantly more people who had an NASS score of 1 in the RTW group than in the non-RTW group (71.4% vs 42.6%, p < 0.05). Failure to RTW was associated with lower level of education, worse baseline back pain (measured with a numeric rating scale), and worse baseline disability (measured with the Oswestry Disability Index [ODI]).CONCLUSIONSThere are a substantial number of patients who are satisfied with surgery even though they did not RTW. Patients who were satisfied with surgery and did not RTW typically had worse preoperative back pain and ODI and typically did not have a college education. While RTW remains an important measure after surgery, physicians should be mindful that patients who do not RTW may still be satisfied with their outcome.

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Characteristics and Clinical Significance of Spondylolisthetic and Spino-pelvic Sagittal Parameters in Kyphotic Low-grade Degenerative Lumbar Spondylolisthesis

10.21203/rs.3.rs-80642/v1 ◽

2020 ◽

Author(s):

Chongqing Xu ◽

Mengchen Yin ◽

Wen Mo

Keyword(s):

Life Quality ◽

Observer Agreement ◽

Common Disease ◽

Low Grade ◽

Significant Difference ◽

Degenerative Lumbar Spondylolisthesis ◽

Sagittal Parameters ◽

Lumbar Spondylolisthesis ◽

The Impact

Abstract Background: Degenerative lumbar spondylolisthesis (DLS) has been a common disease that make increasing patients suffer from different degrees of low back pain and radicular symptoms. At present, the incidence of kyphosis in DLS and the differences in spinal sagittal morphology between kyphotic and non-kyphotic DLS still remain unclear. Our study aimed to determine the incidence of kyphosis in DLS, explore the characteristics of spondylolisthetic and spino-pelvic sagittal parameters, and evaluate the impact of kyphosis on the life quality of patients with DLS.Methods/Design: All 108 patients with L4/5 low-grade DLS were enrolled and divided into kyphotic and non-kyphotic group. 2 spine surgeons who have certain clinical experience were selected to measure the spondylolisthetic and spino-pelvic parameters, as well as visual analogue scale (VAS) and Oswestry disability index (ODI). Differences between the 2 groups and characteristics of measurements were analyzed.Results: The inter-observer agreement of all parameters between the 2 spine surgeons were excellent with each ICC > 0.75. Kyphotic group had higher SA, SD, SDM, SAM, PDH, PT and SVA, and lower ADH, SS and LL than those in non-kyphotic group (p < 0.01). There was no significant difference in PI and TK between the two groups (p > 0.05).Conclusion: The incidence of kyphotic spondylolisthesis in patients with L4/5 low-grade DLS is 16.7%. Compared with those in non-kyphotic group, patients with kyphosis show inferior results of spondylolisthetic parameters, more severe loss of LL, more obvious pelvic retroversion and trunk anteversion, which indicates worse spino-pelvic sagittal balance. In addition, their quality of life was significantly lower than that of patients in non-kyphotic group.

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Utility of Natural Sitting Lateral Radiograph in the Diagnosis of Segmental Instability for Patients with Degenerative Lumbar Spondylolisthesis

Clinical Orthopaedics and Related Research ◽

10.1097/corr.0000000000001542 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Qing-shuang Zhou ◽

Xu Sun ◽

Xi Chen ◽

Liang Xu ◽

Bang-ping Qian ◽

...

Keyword(s):

Lateral Radiograph ◽

Segmental Instability ◽

Degenerative Lumbar Spondylolisthesis ◽

Lumbar Spondylolisthesis

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Predictors of the Best Outcomes Following Minimally Invasive Surgery for Grade 1 Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽

10.1093/neuros/nyaa206 ◽

2020 ◽

Cited By ~ 1

Author(s):

Andrew K Chan ◽

Erica F Bisson ◽

Mohamad Bydon ◽

Steven D Glassman ◽

Kevin T Foley ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Back Pain ◽

Minimally Invasive ◽

Invasive Surgery ◽

Rating Scale ◽

Numeric Rating Scale ◽

Leg Pain ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis

Abstract BACKGROUND The factors driving the best outcomes following minimally invasive surgery (MIS) for grade 1 degenerative lumbar spondylolisthesis are not clearly elucidated. OBJECTIVE To investigate the factors that drive the best 24-mo patient-reported outcomes (PRO) following MIS surgery for grade 1 degenerative lumbar spondylolisthesis. METHODS A total of 259 patients from the Quality Outcomes Database lumbar spondylolisthesis module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis with MIS techniques (188 fusions, 72.6%). Twenty-four-month follow-up PROs were collected and included the Oswestry disability index (ODI) change (ie, 24-mo minus baseline value), numeric rating scale (NRS) back pain change, NRS leg pain change, EuroQoL-5D (EQ-5D) questionnaire change, and North American Spine Society (NASS) satisfaction questionnaire. Multivariable models were constructed to identify predictors of PRO change. RESULTS The mean age was 64.2 ± 11.5 yr and consisted of 148 (57.1%) women and 111 (42.9%) men. In multivariable analyses, employment was associated with superior postoperative ODI change (β-7.8; 95% CI [−12.9 to −2.6]; P = .003), NRS back pain change (β −1.2; 95% CI [−2.1 to −0.4]; P = .004), EQ-5D change (β 0.1; 95% CI [0.01-0.1]; P = .03), and NASS satisfaction (OR = 3.7; 95% CI [1.7-8.3]; P < .001). Increasing age was associated with superior NRS leg pain change (β −0.1; 95% CI [−0.1 to −0.01]; P = .03) and NASS satisfaction (OR = 1.05; 95% CI [1.01-1.09]; P = .02). Fusion surgeries were associated with superior ODI change (β −6.7; 95% CI [−12.7 to −0.7]; P = .03), NRS back pain change (β −1.1; 95% CI [−2.1 to −0.2]; P = .02), and NASS satisfaction (OR = 3.6; 95% CI [1.6-8.3]; P = .002). CONCLUSION Preoperative employment and surgeries, including a fusion, were predictors of superior outcomes across the domains of disease-specific disability, back pain, leg pain, quality of life, and patient satisfaction. Increasing age was predictive of superior outcomes for leg pain improvement and satisfaction.

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101 Lumbar Fusion Versus Laminectomy for Spondylolisthesis: Lessons Learned from the AANS/CNS Spine Section Study Group's Analysis of the N2QOD Registry

Neurosurgery ◽

10.1093/neuros/nyx417.101 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 219-220

Author(s):

Erica Fay Bisson ◽

Mohamad Bydon ◽

Michael S Virk ◽

Steven D Glassman ◽

Kevin T Foley ◽

...

Keyword(s):

Back Pain ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Absolute Difference ◽

Section Study ◽

Pain Scores ◽

Degenerative Lumbar Spondylolisthesis ◽

Lumbar Spondylolisthesis ◽

Level Fusion

Abstract INTRODUCTION The AANS/CNS Spine Section Study Group analyzed 12-month outcomes data from for patients undergoing either laminectomy with fusion or laminectomy alone for grade 1 degenerative spondylolisthesis at ten sites. METHODS 475 patients undergoing elective spine surgery for degenerative grade 1 lumbar spondylolisthesis were identified by retrospective analysis of prospectively collected data from the QOD spine registry. Patients with more than one level fusion were excluded (n = 121) leaving a 354 patient cohort. Patients undergoing 1 level fusion with 1–3 levels of laminectomy (n = 274) were compared to those undergoing 1–3 levels of laminectomy alone (n = 80). RESULTS >For patients presenting with Grade1 spondylolisthesis, 23% (80/354) underwent laminectomy alone while 77% (274/354) underwent 1 level fusion with laminectomy. The percentage of cases returning to the OR within one year was similar for the laminectomy (6.2%) versus the fusion group (6.9%). At baseline, the fusion group had higher NRS back pain (7.0 ± 2.4 vs 5.94 ± 3.0, P< 0.01) and ODI (46.2 ± 15.3 vs 36.8 ± 16.3, P< 0.001) scores than the laminectomy alone group, however, NRS leg pain scores were equivalent. When comparing absolute difference in outcomes at 12-months to baseline, NRS back pain (4.1 ± 2.9 vs 3.1 ± 3.5, P = 0.05) and ODI (25.7 ± 16 vs 19.0 ± 17, P< 0.01) scores improved to a greater extent in the fusion group compared to laminectomy alone group whereas NRS leg pain scores improved equally. Patient satisfaction scores were equivalent for both surgical groups. CONCLUSION The data indicate that fusion with laminectomy for grade 1 degenerative lumbar spondylolisthesis is associated with low readmission and re-operation rates. Patients in the laminectomy with fusion group report more baseline back pain (NRS-back pain) and disability (ODI). Patients undergoing fusion with laminectomy report greater improvement in back pain and less disability at 12-months as compared to those in the lam group, while both groups had equivalent improvement in leg pain.

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