Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low Grade Spondylolisthesis.

dc.contributor.author

Djurasovic, Mladen

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Carreon, Leah Y

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Bisson, Erica F

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Chan, Andrew K

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Bydon, Mohamad

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Mummaneni, Praveen V

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Foley, Kevin T

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Shaffrey, Christopher I

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Potts, Eric A

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Shaffrey, Mark E

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Coric, Domagoj

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Knightly, John J

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Park, Paul

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Wang, Michael Y

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Fu, Kai-Ming

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Slotkin, Jonathan R

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Asher, Anthony L

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Virk, Michael S

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Chou, Dean

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Haid, Regis W

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Glassman, Steven D

dc.date.accessioned

2024-08-20T16:09:19Z

dc.date.available

2024-08-20T16:09:19Z

dc.date.issued

2024-08

dc.description.abstract

Study design

Retrospective review of prospectively collected data.

Objective

To investigate what factors predict delayed improvement after surgical treatment of low grade spondylolisthesis.

Summary of background data

Lumbar surgery leads to clinical improvement in the majority of patients with low grade spondylolisthesis. Most patients improve rapidly after surgery, but some patients demonstrate a delayed clinical course.

Methods

The Quality and Outcomes Database (QOD) was queried for grade 1 spondylolisthesis patients who underwent surgery who had patient reported outcome measures (PROMs) collected at baseline, 3-, 6- and 12-months, including back and leg pain numeric rating scale (NRS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). Patients were stratified as "Early responders" reaching MCID at 3 months and maintaining improvement through 12 months and "Delayed responders" not reaching MCID at 3 months but ultimately reaching MCID at 12 months. These two groups were compared with respect to factors which predicted delayed improvement.

Results

Of 608 patients enrolled, 436 (72%) met inclusion criteria for this study. Overall, 317 patients (72.7%) reached MCID for ODI at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved ODI MCID threshold by the 3-month postop follow-up. 68 patients (21.4%) showed a delayed trajectory, and had not achieved ODI MCID threshold at 3 months, but did ultimately reach MCID at 12-month follow-up. Factors associated with delayed improvement included impaired preoperative ambulatory status, better baseline back and leg pain scores, and worse 3-month leg pain scores (P<0.01).

Conclusions

The majority of patients undergoing surgery for low grade spondylolisthesis reach ODI MCID threshold rapidly, within the first three months after surgery. Factors associated with a delayed clinical course include impaired preoperative ambulation status, relatively better preoperative back and leg pain, and persistent leg pain at 3 months.
dc.identifier

00007632-990000000-00744

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/31414

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000005115

dc.rights.uri

https://creativecommons.org/licenses/by-nc/4.0

dc.title

Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low Grade Spondylolisthesis.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

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