132 - Impact of Age on Decision-Making and Outcomes of Decompression Alone Versus Fusion for L4-5 Degenerative Spondylolisthesis

Saturday, June 3, 2023

11:42 AM – 11:44 AM

Location: Salons 13-15

Co-Author(s)

PS

Pratyush Shahi, MBBS

Hospital for Special Surgery
New York, New York, United States
SS

Sumedha Singh, MD, MBBS

Hospital for Special Surgery, United States
KM

Kyle Morse, MD

Hospital for Special Surgery, New York, United States
OM

Omri Maayan, BS

Hospital for Special Surgery, United States
KA

Kasra Araghi, BS

Research Fellow
Hospital for Special Surgery
Scottsdale, Arizona, United States
NS

Nishtha Singh, MBBS

hospital for special surgery, United States
OT

Olivia Tuma, BS

Hospital for Special Surgery
New York, New York, United States

Presenting Author (Person doing the Podium Present(s)

MK

Maximillian Korsun, BS

Hospital for Special Surgery, United States

Co-Author(s)

AL

Amy Lu, BS

United States
TA

Tomoyuki Asada, MD

Hospital for Special Surgery, United States
ES

Evan Sheha, MD

Hospital for Special Surgery, United States
JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States
TA

Todd J. Albert, MD

Professor
Hospital for Special Surgery
New York, New York, United States
HS

Harvinder S. Sandhu, MD

Surgeon
Hospital for Special Surgery
New York, New York, United States
SQ

Sheeraz A. Qureshi, MD, MBA

Attending Surgeon
Hospital for Special Surgery
York, New York, United States
SI

Sravisht Iyer, MD

Assistant Attending, Spine Surgery
Hospital for Special Surgery
New York, New York, United States

Submitter(s)

JD

James E. Dowdell, MD

Spine Fellow
Hospital for Special Surgery
New York, New York, United States

Disclosure(s):

Omri Maayan, BS: No financial relationships to disclose

Nishtha Singh, MBBS: No financial relationships to disclose

Tomoyuki Asada, MD: No financial relationships to disclose

Sravisht Iyer, MD: No financial relationships to disclose

Introduction
Age can frequently play a decision-making factor in surgical treatment of degenerative spondylolisthesis with older patients tending to be more often decompressed than fused compared to their younger counterparts. Although studies have been conducted comparing the effectiveness of decompression alone and fusion for the treatment of degenerative spondylolisthesis, the impact of age on comparative outcomes has not been studied.

Aims/Objectives
To compare the outcomes of decompression alone and fusion for L4-5 degenerative spondylolisthesis in different age cohorts.

Methods
This retrospective cohort study included patients who underwent minimally invasive laminectomy or fusion for degenerative spondylolisthesis at L4-5 and had a minimum of 1-year follow-up. Patients were stratified into 2 cohorts based on age: < 70 years, >70 years. Outcome measures were: 1) patient-reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale back and leg, VAS; 12-Item Short Form Survey Physical Component Score, SF-12 PCS), 2) minimal clinically important difference (MCID) for PROMs, 3) patient acceptable symptom state(PASS) (denoted by postoperative ODI < 25.2; Shahi et al, 2022), and 4) response on the global rating change (GRC) scale (Compared to preoperative, you feel better, same, or worse?). Two postoperative timepoints were analyzed – early ( < 6 months) and late (>6 months). For both age cohorts, the decompression and fusion groups were compared in terms of outcomes with univariate analyses.

Results
233 patients were included. 122 (52%) were < 70 years, 111 (48%) were >70 years. In the < 70-year age cohort, 22% of patients underwent decompression alone and 78% underwent fusion. In the >70-year age cohort, 54% of patients underwent decompression alone and 46% underwent fusion.
Analysis of the < 70-year age cohort showed patients who underwent decompression did not achieve statistically significant improvement in SF-12 PCS at < 6 and >6 months compared to the preoperative baseline but showed significant improvement in the other PROMs. The fusion group, on the other hand, showed significant improvement in all PROMs at both timepoints(Table 1). Patients < 70 years who underwent decompression showed significantly lower MCID achievement rates for VAS back at < 6 months (50% vs 72% after fusion, p=0.02) and >6 months (47% vs 76% after fusion, p=0.02). MCID achievement rates for other PROMs, PASS achievement rates, and responses on the GRC scale did not show any significant differences between the decompression and fusion groups.
Analysis of the >70-year age cohort showed that both decompression and fusion groups attained significant improvement in all PROMs at < 6 and >6 months compared to the preoperative baseline with no significant difference in the magnitude of improvement between the two groups (Table 1). MCID achievement rates for all PROMs, PASS achievement rates, and responses on the GRC scale did not show any significant differences between the decompression and fusion groups.

Conclusions
Patients < 70 years undergoing decompression alone for L4-5 degenerative spondylolisthesis showed less improvement in back pain and physical function compared to those undergoing fusion. Patients >70 years, on the other hand, did not show any difference in outcomes based on the surgery type.