208. Should patients with lumbar stenosis and Grade I spondylolisthesis be treated differently based on spinopelvic alignment? A comparison of clinical and patient reported outcomes within a single health system

BACKGROUND CONTEXT

Degenerative spondylolisthesis of the lumbar spine is one of the most common pathologies addressed by surgeons. Recently, high-level data demonstrated improved outcomes with fusion in conjunction with laminectomy compared to laminectomy alone.

PURPOSE

The present study is the first analysis to examine the effect of spinopelvic alignment on patient-reported outcomes following decompression alone versus decompression with fusion.

STUDY DESIGN/SETTING

Subgroup analysis of observational prospective cohort study.

PATIENT SAMPLE

A total of 679 patients with degenerative Grade I spondylolisthesis and stenosis treated with laminectomy alone or laminectomy with fusion at a tertiary care insitution.

OUTCOME MEASURES

Primary outcome was the change in Patient-Reported Outcome Measurement Information System (PROMIS), Global Physical Health (GPH), and Global Mental Health (GMH) scores at baseline and postoperatively at 6 and 12 months.

METHODS

Patients underwent laminectomy alone or laminectomy with instrumented fusion for degenerative Grade I lumbar spondylolisthesis and stenosis. Four cohorts were created based on pelvic incidence minus lumbar lordosis (PILL): (1) fusion with PILL>10°, (2) fusion with PILL10°, and (4) decompression alone with PILL <10°. The between-group comparisons of PROMIS GPH/GMH score changes were analyzed using mixed-effects models. Analyses were conducted independently for the following: (1) unmatched cohort, (2) 1:1 propensity score matched patients (PSM), (3) coarsened exact matched (CEM) patients.

RESULTS

A total of 49.9% (339) underwent lumbar decompression with fusion, while 50.1% (340) received decompression. When comparing low spinopelvic mismatch (PILL 10) patients, fusion-treated patients had improved postoperative PROs (GMH: 26.61 vs 20.75, p < 0.0001; GPH: 23.61 vs 18.13, p < 0.0001) at 10-12 months. Mixed effect modeling confirmed GPH score improvement was 5.11 (2.08 - 8.13) points higher at 10-12 months in the fusion group.

CONCLUSIONS

Among Grade I spondylolisthesis patients with PILL>10°, laminectomy with fusion was associated with greater improvement in physical health-related quality of life than laminectomy alone.

FDA DEVICE/DRUG STATUS

This abstract does not discuss or include any applicable devices or drugs.