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Quality of Life and Slip Progression in Degenerative Spondylolisthesis Treated Nonoperatively

Cushnie, Duncan, MD∗,‡; Johnstone, Ryan, MD∗,‡; Urquhart, Jennifer C., PhD†,‡; Gurr, Kevin R., MD∗,†,‡; Bailey, Stewart I., MD∗,†,‡; Bailey, Christopher S., MD∗,†,‡

doi: 10.1097/BRS.0000000000002429

Study Design. A prospective cohort study of consecutive patients.

Objective. Determination of the quality of life (QoL) and prevalence of slip progression in patients with degenerative lumbar spondylolisthesis managed nonoperatively.

Summary of Background Data. Lumbar spinal stenosis secondary to degenerative lumbar spondylolisthesis is a common radiographic diagnosis associated with chronic back pain and radicular symptoms. There is limited evidence as to the clinical course in terms of validated QoL measures, and the extent of slip progression in patients with this condition treated nonoperatively.

Methods. Validated disease-specific and generic QoL metrics including SF12 physical and mental scores [SF12-physical component summary (PCS) and SF12-mental component summary (MCS)], Oswestry Disability Index (ODI), and numeric scales for back and leg pain as well as radiographic assessment of slip extent were evaluated at initial consultation (baseline) and at a minimum of 5 years after the baseline assessment. Slip progression was defined by a >5% increase in slip percentage.

Results. Thirty-nine of 160 (24.4%) patients elected to switch to operative management, despite no slip progression on preoperative radiographs. Seventy spondylolisthetic levels in 66 participants were assessed after a minimum of 5 years of nonoperative management. Twenty-one participants (31.8%) had slip progression. SF12-PCS, ODI, and leg pain improved similarly in both groups (P < 0.05). SF12-MCS did not change significantly in either group. Back pain improved only in the nonprogressing group.

Conclusion. The majority of cases of low-grade spondylolisthesis do not progress over 5 years with nonoperative management. Regardless of whether there was progression or not, the mean PCS, ODI, and leg pain improved from baseline, although symptoms remained and a significant number elected to switch to surgical management before 5 years. Back pain improved with nonoperative treatment only in those without progression.

Level of Evidence: 2

Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada

Lawson Health Research Institute, London, Ontario, Canada

London Health Sciences Center, London, Ontario, Canada.

Address correspondence and reprint requests to Christopher S. Bailey, MD, London Health Science Centre, University of Western Ontario, London, ON N6A 5W9, Canada; E-mail:

Received 15 June, 2017

Revised 26 August, 2017

Accepted 12 September, 2017

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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