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Rationale for the Surgical Treatment of Lumbar Degenerative Spondylolisthesis

Schroeder, Gregory D. MD; Kepler, Christopher K. MD, MBA; Kurd, Mark F. MD; Vaccaro, Alexander R. MD, PhD; Hsu, Wellington K. MD; Patel, Alpesh A. MD; Savage, Jason W. MD

doi: 10.1097/BRS.0000000000001116
Health Services Research
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Study Design. A questionnaire survey.

Objective. The aim of this study was to determine the effect of patient age, dynamic instability, and/or low back pain on the treatment of patients with a degenerative spondylolisthesis, and if the operative approach is affected by surgeon specialty, location, or practice model.

Summary of Background Data. The classic treatment for patients with symptomatic degenerative spondylolisthesis is decompression and fusion; however in a select group of patients, an isolated decompression may be reasonable.

Methods. A survey was sent to surgeon members of the Lumbar Spine Research Society and AOSpine requesting information regarding their preferred treatment of degenerative spondylolisthesis for a number of different clinical scenarios. Determinants included patient age, the presence of instability, symptoms of low back pain, surgeon's location, surgeon's specialty, and practice model.

Results. A total of 223 spine surgeons completed the survey. Age of the patient, the presence of instability, and low back pain all significantly (P < 0.0001) affected the recommended treatment, which were independent of surgeon factors. Older patients were significantly less likely to be offered an interbody fusion and more likely to be recommended for an isolated decompression (P < 0.0001), and the presence of dynamic instability made an interbody fusion more likely than an isolated decompression (P < 0.0001). Of those who responded, 53.2% of surgeons reported they would recommend an isolated decompression for a properly selected patient with a degenerative spondylolisthesis.

Conclusion. The most common operative treatment for a degenerative spondylolisthesis is a decompression and fusion; however, the results of this survey demonstrate that surgeons consider degenerative spondylolisthesis a heterogeneous condition that requires an individualized surgical plan. Future studies are needed to evaluate the effect of variables such as age, the presence of low back pain, and the presence of dynamic instability on patient reported outcomes from various surgical options.

Level of Evidence: N/A.

Supplemental Digital Content is available in the text

*The Rothman Institute at Thomas Jefferson University, Philadelphia, PA

The Northwestern University Department of Orthopaedic Surgery, Chicago, IL

The department of Orthopaedic Surgery at the Cleveland Clinic, Cleveland, OH.

Address correspondence and reprint requests to Gregory D. Schroeder, MD, The Rothman Institute, 925 Chestnut Street, 5th floor, Philadelphia, PA; E-mail: gregdschroeder@gmail.com

Received 3 February, 2015

Revised 4 June, 2015

Accepted 6 August, 2015

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, stocks, travel/accommodations/meeting expenses.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.