Incidence of revision surgery and patient-reported outcomes within 5 years of the index procedure for grade 1 spondylolisthesis: an analysis from the Quality Outcomes Database spondylolisthesis data.

Autor:	Birlingmair J; 1Norton Leatherman Spine Center, Louisville, Kentucky., Carreon LY; 1Norton Leatherman Spine Center, Louisville, Kentucky., Djurasovic M; 1Norton Leatherman Spine Center, Louisville, Kentucky., Mummaneni PV; 2Department of Neurological Surgery, University of California, San Francisco, California., Asher A; 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina., Bisson EF; 4Department of Neurosurgery, Clinical Neurosciences Center, University of Utah Health, Salt Lake City, Utah., Bydon M; 5Department of Neurologic Surgery, College of Medicine and Science, Mayo Clinic, Rochester, Minnesota., Chan AK; 6Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York., Chou D; 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York., Coric D; 3Department of Neurosurgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina., Foley KT; 8Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee., Fu KM; 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York., Haid R; 9Department of Neurosurgery, Atlanta Brain and Spine Care, Atlanta, Georgia., Knightly JJ; 10Department of Neurosurgery, Atlantic Neurosurgical Specialists and Altair Health, Morristown, New Jersey., Le VP; 2Department of Neurological Surgery, University of California, San Francisco, California., Park P; 8Department of Neurosurgery, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee., Potts EA; 11Goodman Campbell Brain and Spine, Carmel, Indiana., Shaffrey CI; 12Departments of Neurosurgery and Orthopedic Surgery, Duke University Hospital, Durham, North Carolina., Shaffrey ME; 13Department of Neurosurgery, University of Virginia, Charlottesville, Virginia., Slotkin JR; 14Department of Neurosurgery, Geisinger Health, Danville, Pennsylvania; and., Virk MS; 7Department of Neurosurgery, Weill Cornell Medical Center, New York, New York., Wang MY; 15Department of Neurological Surgery, University of Miami, Florida., Glassman SD; 1Norton Leatherman Spine Center, Louisville, Kentucky.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2024 Oct 11, pp. 1-6. Date of Electronic Publication: 2024 Oct 11.
DOI:	10.3171/2024.6.SPINE24488
Abstrakt:	Objective: Some patients treated surgically for grade 1 spondylolisthesis require revision surgery. Outcomes after revision surgery are not well studied. The objective of this study was to determine how revision surgery impacts patient-reported outcomes (PROs) in patients undergoing decompression only or decompression and fusion (D+F) for grade 1 spondylolisthesis within 5 years of the index surgery. Methods: Patients in the 12 highest Quality Outcomes Database (QOD) enrolling sites with a diagnosis of grade 1 spondylolisthesis were identified and the incidence of revision surgery between the decompression-only and D+F patients were compared. PROs were compared between cohorts requiring revision surgery versus a single index procedure. Results: Of 608 patients enrolled, 409 had complete 5-year data available for this study. Eleven (13.3%) of 83 patients underwent revision in the decompression-only group as well as 32 (9.8%) of 326 in the D+F group. For the entire cohort, patients requiring revision had significantly worse PROs at 5 years: Oswestry Disability Index (ODI) 27.4 versus 19.4, p = 0.008; numeric rating scale for back pain (NRS-BP) 4.1 versus 3.0, p = 0.013; and NRS for leg pain (NRS-LP) 3.4 versus 2.1, p = 0.029. In the decompression-only group, the change in 5-year PROs was not impacted by revision status: ODI 31.9 versus 24.2, p = 0.287; NRS-BP 1.9 versus 2.9, p = 0.325; and NRS-LP 6.2 versus 3.7, p = 0.011. In the D+F group, the change in 5-year PROs was diminished if patients required revision: ODI 19.1 versus 29.1, p = 0.001; NRS-BP 3.0 versus 4.0, p = 0.170; and NRS-LP 2.3 versus 4.6, p = 0.001. Conclusions: The most common reasons for reoperation within 5 years in the decompression-only group were repeat decompression and instability, whereas in the D+F group the most common reason was adjacent-segment disease. The need for revision resulted in modestly diminished benefit compared with patients with no revisions. These differences were greater in the fusion cohort compared with the decompression-only cohort. The mean PRO improvement still far exceeded minimal clinically important difference thresholds for all measures for patients who underwent a revision surgery.
Databáze:	MEDLINE
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