Journal
SPINE
Volume 33, Issue 25, Pages 2759-2766Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BRS.0b013e31818e2d8b
Keywords
radiograph; surgery; degenerative spondylolisthesis; outcomes; nonoperative
Categories
Funding
- National Institute of Arthritis
- Musculoskeletal and Skin Diseases [U01-AR45444-01A1]
- Office of Research on Women's Health
- National Institutes of Health
- National Institute of Occupational Safety and Health
- Centers for Disease Control and Prevention
- NIAMS [P60-AR048094-01A1, T32-AR-049710, 1 K23 AR048138-01]
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Study Design. Subgroup analyses according to treatment received. Objective. To evaluate whether baseline radiographic findings predicted outcomes in patients with degenerative spondylolisthesis. Summary of Background Data. The spine patient outcomes research trial combined randomized and observational DS cohorts. Methods. The Meyerding listhesis grade was determined on the neutral radiograph (n = 222). Patients were classified as having low disc height if disc height was less than 5 mm. Flexion-extension radiographs (n = 185) were evaluated for mobility. Those with greater than 10 rotation or 4 mm translation were considered hypermobile. Changes in outcome measures were compared between listhesis (grade 1 vs. grade 2), disc height (low vs. normal), and mobility (stable vs. hypermobile) groups using longitudinal regression models adjusted for potential confounders. Outcome measures included SF-36 bodily pain and physical function scales, oswestry disability index (ODI), stenosis bothersomeness index, and low back pain bothersomeness scale. Results. Overall, 86% had a grade 1 listhesis, 78% had normal disc height, and 73% were stable. Baseline symptom severity was similar between groups. Overall, surgery patients improved more than patients treated non-operatively. At 1 year, outcomes were similar in surgery patients across listhesis, disc height, and mobility groups (ODI: grade 1 -23.7 vs. grade 2 -23.3, P = 0.90; normal disc height -23.5 vs. low disc height -21.9, P = 0.66; stable -21.6 vs. hypermobile -25.2, P = 0.30). Among those treated nonoperatively, grade 1 patients improved more than grade 2 patients (bodily pain + 13.1 vs. -4.9, P = 0.019; ODI -8.0 vs. -4.8, P = 0.010 at 1 year), and hypermobile patients improved more than stable patients (ODI -15.2 vs. -6.6, P = 0.041; stenosis bothersomeness index -7.8 vs. -2.7, P = 0.002 at 1 year). Discussion. Regardless of listhesis grade, disc height or mobility, patients who had surgery improved more than those treated nonoperatively. These differences were due, in part, to differences in nonoperative outcomes, which were better in patients classified as grade 1 or hypermobile.
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