Predictive Factors Affecting Surgical Outcomes in Patients with Degenerative Lumbar Spondylolisthesis

Study design: Post-hoc analysis of 5-year follow-up data from a prospective randomized multicenter trial.

Objective: The purpose of this study was to identify preoperative factors that predict poor postoperative outcomes and define clinically important abnormal instabilities in degenerative lumbar spondylolisthesis.

Summary of background data: Current evidence regarding prognostic factors affecting clinical outcomes after surgery for degenerative lumbar spondylolisthesis is still limited. Moreover, there is no consensus regarding parameters that define clinically important abnormal instability in patients with degenerative lumbar spondylolisthesis.

Methods: This post-hoc analysis from a prospective randomized trial that compared the effectiveness of decompression, decompression with fusion, and decompression with stabilization for degenerative lumbar spondylolisthesis at the L4/5 level included 70 patients with a 5-year follow-up period. We investigated the correlation between the postoperative recovery rate and preoperative radiographic parameters. We then investigated differences between the good recovery and poor recovery groups.

Results: Japanese Orthopaedic Association and visual analogue scale scores improved postoperatively. Of the 70 patients analyzed, 13 were judged to be in the poor recovery group based on their recovery rate. The recovery rate significantly correlated with the intervertebral angle at L4/5. Univariate analysis showed that while the degree of vertebral slippage and the presence of angulation were not associated with poor recovery, the intervertebral angle at L4/5 and the presence of translation were associated with poor recovery. Lastly, multiple stepwise logistic regression analysis revealed the intervertebral angle at L4/5 and the presence of translation as independent predictors of poor recovery after surgery for lumbar degenerative spondylolisthesis.

Conclusion: While the degree of vertebral slippage and the presence of angulation were not associated with poor recovery after surgery for lumbar degenerative spondylolisthesis, postoperative outcomes were associated with the intervertebral angle and the presence of translation. Careful preoperative measurement of these factors may help to predict poor postoperative outcomes.Level of Evidence: 3.