Radiographic Predictors of Functional Outcome in Degenerative Lumbar Spondylolisthesis Surgery
Abstract
Objective: To confirm the importance of sagittal spinal alignment on functional outcome with degenerative lumbar spondylolisthesis (DLS) surgery and to identify the radiographic parameters that predict functional outcomes after DLS surgery.
Methods: Retrospective analysis of the prospectively collected functional and radiographic outcomes of the Canadian Spine Outcomes and Research Network DLS database. All patients underwent either decompression, posterolateral fusion or interbody fusion surgery with a minimum of one-year postoperative follow-up.
Results: Most patients improve or remain unchanged in their sagittal spinal alignment regardless of surgery type with fusion procedures not experiencing statistically significantly improved alignment changes to decompression alone. By multiple linear regression adjusted for baseline patient age, body mass index, gender and preoperative presence of depression, worsening of a patient’s pelvic incidence-lumbar lordosis (LL) mismatch with any technique of DLS surgery was associated with a higher one-year postoperative ODI score R2 0.179 (95% CI 0.080, 0.415, p=0.004), back pain R2 0.152 (95% CI 0.021, 0.070, p 2 0.059 (95% CI 0.008, 0.066, p=0.014) score. Likewise, reduction of LL was associated with a higher ODI score R2 0.168 (-0.387, -0.024, p=0.027) and back pain R2 0.135 (95% CI -0.064, -0.010, p=0.007).
Conclusions: This is the first work to examine DLS patients outside of extrapolated sagittal balance parameters from the adult scoliosis literature. Importantly, we show that any worsening in sagittal spinal alignment parameters with DLS surgery regardless of surgery type leads to poorer functional outcomes even among patients who remain within conventionally held appropriate sagittal balance.