Factors, affecting functional outcomes in patients with low-grade isthmic spondylolisthesis after surgical treatment

Transforaminal lumbar interbody fusion with posterior instrumentation is widely used to treat patients with low-grade isthmic spondylolisthesis. Current evidence regarding factors that may affect functional outcomes is still controversial.

OBJECTIVE. To identify the factors that may affect the severity of functional adaptation disorders in patients with low-grade isthmic spondylolisthesis after surgery.

METHODS. Fourty-eight patients older than 18 years with isthmic spondylolisthesis who underwent transforaminal lumbar interbody fusion and posterior screw-rod instrumentation from 2018 to 2020, were retrospectively analyzed. The effect of gender, age, obesity, smoking, paravertebral muscle condition, the interbody height, degree of vertebral translation prior to surgery, amount of vertebral reduction performed, initial level of functional condition, approach to performing of interbody fusion and instrumentation on functional outcome measured by Oswestry scale was analyzed.

RESULTS. The degree of functional desadaptation after surgical treatment can be reliably affected by the patient’s excess body weight (BMI > 30) (p = 0.044). During the correlation analysis, a statistically significant association was observed between the degree of functional desadaptation of patients after surgery with initial functional status (rho = 0.418, p = 0.003) and the relative size of the psoas muscle (rho = –0.327, p = 0.023).

CONCLUSION. This study showed that adverse functional outcomes in patients with low-grade isthmic spondylolisthesis may be associated with obesity, functional status prior to surgery, the relative size of the psoas muscle. For this reason, it is necessary inform patients that some of the factors are modifiable, which means lifestyle correction, obesity treatment can significantly reduce the degree of functional desadaptation after surgery.

1. Kalichman L, Li L, Hunter DJ, Been E. Association between computed tomography–evaluated lumbar lordosis and features of spinal degeneration, evaluated in supine position. The Spine Journal. 2011;11(4):308–315. doi:10.1016/j.spinee.2011.02.010

2. Bulatov A, Klimov V, Evsyukov A. Surgical treatment of low grade spondylolisthesis: the modern state of the problem. Hirurgiâ pozvonočnika. 2016;13(3):68–77 (In Russ.).

3. Cavalier R, Herman MJ, Cheung E v., Pizzutillo PD. Spondylolysis and Spondylolisthesis in Children and Adolescents: I. Diagnosis, Natural History, and Nonsurgical Management. Journal of the American Academy of Orthopaedic Surgeons. 2006;14(7):417–424. doi:10.5435/0012463520060700000004

4. Azizpour K, Schutte P, Arts MP, et al. Decompression alone versus decompression and instrumented fusion for the treatment of isthmic spondylolisthesis: a randomized controlled trial. J Neurosurg Spine. 2021;35(6):687–697. doi:10.3171/2021.1. SPINE201958

5. Athiviraham A, Wali ZA, Yen D. Predictive factors influencing clinical outcome with operative management of lumbar spinal stenosis. The Spine Journal. 2011;11(7):613–617. doi:10.1016/j.spinee.2011.03.008

6. Kim GU, Park J, Kim HJ, et al. Definitions of unfavorable surgical outcomes and their risk factors based on disability score after spine surgery for lumbar spinal stenosis. BMC Musculoskelet Disord. 2020;21(1):288. doi:10.1186/s12891020033230

7. Chan AK, Bisson EF, Bydon M, et al. Obese Patients Benefit, but do not Fare as Well as Nonobese Patients, Following Lumbar Spondylolisthesis Surgery: An Analysis of the Quality Outcomes Database. Neurosurgery. 2020;86(1):80–87. doi:10.1093/neuros/nyy589

8. Macki M, Alvi MA, Kerezoudis P, et al. Predictors of patient dissatisfaction at 1 and 2 years after lumbar surgery. J Neurosurg Spine. 2020;32(3):373–382. doi:10.3171/2019.8. SPINE19260

9. Rihn JA, Radcliff K, Hilibrand AS, et al. Does Obesity Affect Outcomes of Treatment for Lumbar Stenosis and Degenerative Spondylolisthesis? Analysis of the Spine Patient Outcomes Research Trial (SPORT). Spine (Phila Pa 1976). 2012;37(23):1933–1946. doi:10.1097/BRS.0b013e31825e21b2

10. Cobo Soriano J, Sendino Revuelta M, Fabregate Fuente M, Cimarra Díaz I, Martínez Ureña P, Deglané Meneses R. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. European Spine Journal. 2010;19(11):1841–1848. doi:10.1007/s0058601012842

11. Hagenmaier HF, Delawi D, Verschoor N, Oner FC, van Susante JL. No correlation between slip reduction in low-grade spondylolisthesis or change in neuroforaminal morphology and clinical outcome. BMC Musculoskelet Disord. 2013;14(1):245. doi:10.1186/1471247414245

12. Stanuszek A, Jędrzejek A, Gancarczyk-Urlik E, et al. Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease. Arch Orthop Trauma Surg. Published online January 23, 2021. doi:10.1007/s00402–021–03754-x

13. Rodríguez-Vela J, Lobo-Escolar A, Joven E, Muñoz-Marín J, Herrera A, Velilla J. Clinical outcomes of minimally invasive versus open approach for one-level transforaminal lumbar interbody fusion at the 3- to 4-year follow-up. European Spine Journal. 2013;22(12):2857– 2863. doi:10.1007/s00586–013–2853-y

14. Ganesan S, Jayabalan V, Kumar V, Kailash K. Clinical and Radiological Outcomes of Modified Mini-Open and Open Transforaminal Lumbar Interbody Fusion: A Comparative Study. Asian Spine J. 2018;12(3):544–550. doi:10.4184/asj.2018.12.3.544

15. Gushcha AO, Yusupova AR. Evaluation of outcomes of surgical treatment for degenerative diseases of the spine. Hirurgiâ pozvonočnika. 2017;14(4):85–94. (In Russ.).

16. Cherepanov E. A. Russian version of the oswestry disability index: cross-cultural adaptation and validity. Hirurgiâ pozvonočnika (Spine Surgery). 2009;3:093–098 (In Russ.).

17. Ulutaş M, Yaldız C, Seçer M, et al. Comparison of Wiltse and classical methods in surgery of lumbar spinal stenosis and spondylolisthesis. Neurol Neurochir Pol. 2015;49(4):251–257. doi:10.1016/j.pjnns.2015.06.005

18. Bach K, Ford J, Foley R, et al. Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study. World Neurosurg. 2019;124: e106-e118. doi:10.1016/j.wneu.2018.12.014

19. Stanuszek A, Jędrzejek A, Gancarczyk-Urlik E, et al. Preoperative paraspinal and psoas major muscle atrophy and paraspinal muscle fatty degeneration as factors influencing the results of surgical treatment of lumbar disc disease. Arch Orthop Trauma Surg. Published online January 23, 2021. doi:10.1007/s00402–021–03754-x

20. Kjaer P, Bendix T, Sorensen JS, Korsholm L, Leboeuf-Yde C. Are MRI-defined fat infiltrations in the multifidus muscles associated with low back pain? BMC Med. 2007;5(1):2. doi:10.1186/1741701552

21. Guan F, Yin H, Zhu L, et al. Risk factors of postoperative low back pain for low-grade isthmic spondylolisthesis: a retrospective study. Journal of International Medical Research. 2020;48(3):030006051989079. doi:10.1177/0300060519890791

22. Kim GU, Park J, Kim HJ, et al. Definitions of unfavorable surgical outcomes and their risk factors based on disability score after spine surgery for lumbar spinal stenosis. BMC Musculoskelet Disord. 2020;21(1):288. doi:10.1186/s12891020033230

23. Aghayev E, Mannion AF, Fekete TF, et al. Risk Factors for Negative Global Treatment Outcomes in Lumbar Spinal Stenosis Surgery: A Mixed Effects Model Analysis of Data from an International Spine Registry. World Neurosurg. 2020;136: e270-e283. doi:10.1016/j.wneu.2019.12.147

24. Sielatycki JA, Chotai S, Stonko D, et al. Is obesity associated with worse patient-reported outcomes following lumbar surgery for degenerative conditions? European Spine Journal. 2016;25(5):1627–1633. doi:10.1007/s0058601644601

25. Divi SN, Goyal DKC, Galetta MS, et al. How Does Body Mass Index Influence Outcomes in Patients After Lumbar Fusion? Spine (Phila Pa 1976). 2020;45(8):555–561. doi:10.1097/BRS.0000000000003313

26. Desai A, Ball PA, Bekelis K, et al. Surgery for Lumbar Degenerative Spondylolisthesis in Spine Patient Outcomes Research Trial. Spine (Phila Pa 1976). 2012;37(5):406–413. doi:10.1097/BRS.0b013e3182349bc5

27. Stienen M, Richter H, Prochnow N, Schnakenburg L, Gautschi O. Beeinflusst Rauchen Rückenschmerzen und spinale Operationsergebnisse? Z Orthop Unfall. 2011;149(03):317–323. doi:10.1055/s0030–1270706

28. Okuda S, Oda T, Yamasaki R, Haku T, Maeno T, Iwasaki M. Posterior lumbar interbody fusion with total facetectomy for lowdysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes. J Neurosurg Spine. 2014;21(2):171–178. doi:10.3171/2014.4. SPINE 13925

29. Song X, Ren D, Wu D, Zhang F, Han S, Wang J. Transforaminal lumbar interbody fusion with reduction of slippage of vertebrae for isthmic lumbar spondylolisthesis: Unilateral versus bilateral interbody fusion. Clin Neurol Neurosurg. 2021;203:106588. doi:10.1016/j.clineuro.2021.106588

30. Wang W, Li W, Chen Z. Risk factors for screw loosening in patients with adult degenerative scoliosis: the importance of paraspinal muscle degeneration. J Orthop Surg Res. 2021;16(1):448. doi:10.1186/s13018–021–02589-x