Employment is Associated with Superior Patient Reported Outcomes following Minimally Invasive Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database

Presented at SMISS Annual Forum 2018
By Andrew Chan MD
With Erica Bisson MD, MPH, Mohamad Bydon MD, Steven Glassman MD, Kevin T. Foley MD, Eric Potts MD, Christopher Shaffrey MD, Mark Shaffrey MD, Domagoj Coric MD, John Knightly MD, Paul Park MD, Michael Wang MD, Kai-Ming Fu MD, Jonathan Slotkin MD, Anthony Asher MD, Panagiotis Kerezoudis MD, M.S., Regis Haid MD, Praveen Mummaneni MD,

Disclosures: Andrew Chan MD None Erica Bisson MD, MPH B; nView, Mohamad Bydon MD None, Steven Glassman MD B; Medtronic. F; Medtronic, Kevin Foley MD B; Medtronic. D; Medtronic; Nuvasive; Spine Wave. F; Medtronic, Eric Potts MD F; Medtronic., Christopher Shaffrey MD None, Mark Shaffrey MD None, Domagoj Coric MD B; Spine Wave; Stryker; Medtronic; Premia Spine. D; Spine Wave; Premia Spine; Spinal Kinetics, John Knightly MD None, Paul Park MD B; Biomet, Globus, Medtronic, Nuvasive. F; Globus, Michael Wang MD None, Kai-Ming Fu MD B; Globus, Depuy Synthes, Sibone, 4web, Jonathan Slotkin MD B; Stryker, Anthony Asher MD None, Panagiotis Kerezoudis MD, M.S. None, Regis Haid MD B; Nuvasive. D; Spine Universe. F; Nuvasive; Medtronic, Praveen Mummaneni MD B; Globus,

Introduction:

The factors driving the best outcomes following minimally invasive surgery (MIS) for grade 1 lumbar spondylolisthesis are not clearly elucidated.

Aims/Objectives:

This study investigates the factors that drive the best 12-month patient reported outcomes (PRO) following MIS lumbar spondylolisthesis surgery.

Methods:

797 patients from twelve high-enrolling sites participating in the Quality Outcomes Database (QOD) Spondylolisthesis Module underwent surgery for degenerative grade 1 lumbar spondylolisthesis. Surgeries were classified as MIS if any of the following were involved: MIS laminectomy, MIS pedicle screws, MIS interbody grafts, cortical screws, or percutaneous screws. Baseline and 12-month follow-up parameters were collected. PROs included the numeric rating scale (NRS) Back Pain, NRS Leg Pain, Oswestry Disability Index (ODI), and EuroQoL-5D (EQ-5D) Questionnaire. Multivariate models were constructed which included adjustment for patient characteristics (age, gender, body mass index, comorbidities, smoking status), presentation characteristics (dominant presenting symptoms, motor deficit on presentation, ambulation status, symptom duration), surgical variables (surgical approach, fusion versus nonfusion surgery), socioeconomic characteristics (ethnicity, education, employment status, insurance type), and baseline PRO values.

Results:

318 (39.9%) patients underwent surgery via MIS techniques. The mean age of the MIS cohort was 63.9 ± 11.4 years and consisted of 180 (56.6%) women. At presentation, 136 (42.8%) were employed (employed and/or employed on leave). In multivariate analyses, employment status remained the sole significant predictor of superior MIS outcomes across the four PROs at 12 months (ODI OR=0.004 95% CI [0.0001-0.35], p=0.02, NRS back pain OR=0.45 [0.24-0.86], p=0.02, NRS leg pain OR=0.40 [0.21-0.78], p=0.01, and EQ-5D OR=1.06 [1.02-1.11], p=0.01). Aside from baseline PRO values, additional 12-month MIS predictors of (1) ODI included 4 years of education or greater (OR=0.01 [0.0002-0.82], p=0.04), (2) NRS Back Pain included fusion surgery (OR=0.45 [0.20-0.996], p=0.049), (3) NRS Leg Pain included baseline anxiety (OR=3.20 [1.07-9.51], p=0.04), independent ambulation at baseline (OR=0.38 [0.16-0.92], p=0.03), and (4) EQ-5D included baseline depression (OR=0.93 [0.87-0.99], p=0.02), independent ambulation (OR=1.08 [1.02-1.15], p=0.01), and presence of a motor deficit at presentation (OR=0.95 [0.90-0.99], p=0.02). The multivariate analyses were repeated with the 479 (60.1%) open surgical patients, which did not identify employment as a significant predictor of ODI, NRS back pain, NRS leg pain, or EQ-5D (all p>0.05).

Conclusions:

Multiple factors affect 12-month outcomes following lumbar spondylolisthesis surgery. For MIS, but not open spondylolisthesis surgery, employment status remained the sole significant predictor of best outcomes across the four domains of disease-specific disability, back pain, leg pain, and health-related quality of life.