Robert A Ravinsky1, Eric J Crawford2,3, Luke A Reda2, Y Raja Rampersaud4,5,6. 1. Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, 755 E. McDowell Rd, 2nd Floor, Phoenix, AZ, 85006, USA. 2. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON, M5T 1P5, Canada. 3. Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, M5T 3M7, Canada. 4. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON, M5T 1P5, Canada. raja.rampersaud@uhn.ca. 5. Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, First Floor, East Wing, Room 1E441, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada. raja.rampersaud@uhn.ca. 6. Arthritis Program, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada. raja.rampersaud@uhn.ca.
Abstract
PURPOSE: The aim of this study is to determine whether there is a relationship between radiographic slip progression and symptomatic worsening after decompression without fusion for low-grade degenerative lumbar spondylolisthesis (DLS). METHODS: A retrospective review of 1-2-level minimally invasive surgical decompression for grade I-II DLS was performed. Included subjects had a minimum of 1-year follow-up with prospectively collected baseline and follow-up Oswestry Disability Index (ODI) scores. RESULTS: Fifty-six patients (33 females, 58.9%), having a mean age 65.6 years (SD 10.0), met inclusion criteria. Spondylolisthesis slip percentage increased in 55.4% (31/56) of patients. Slip percentage increased significantly (p = 0.002) from baseline (mean 17.2; SD 8.0) to follow-up (mean 20.1; SD 9.6). A logistic regression model identified that females were more likely to have progressive slips compared to males (odd ratio 6.09, 95% CI 1.77-21.01; p = 0.004). ODI scores and spondylolisthesis slip percentage did not correlate at baseline (r = 0.0170; p = 0.90) nor follow-up (r = 0.094; p = 0.49). There was no correlation between the change in ODI scores and change in slip percentage from baseline to final follow-up (r = 0.0474; p = 0.73). Of the 31 patients with slip progression, there was no difference in mean ODI score changes (p = 0.91) for those with 1-5% progression (13/31 [41.9%]; - 18.0 [SD 19.7]) compared to those with > 5% slip progression (18/31 [58.1%]; - 18.7 [SD 16.4]). CONCLUSIONS: Despite a small degree of slip progression in the majority of patients, there was no correlation with symptom worsening, as measured by the ODI. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The aim of this study is to determine whether there is a relationship between radiographic slip progression and symptomatic worsening after decompression without fusion for low-grade degenerative lumbar spondylolisthesis (DLS). METHODS: A retrospective review of 1-2-level minimally invasive surgical decompression for grade I-II DLS was performed. Included subjects had a minimum of 1-year follow-up with prospectively collected baseline and follow-up Oswestry Disability Index (ODI) scores. RESULTS: Fifty-six patients (33 females, 58.9%), having a mean age 65.6 years (SD 10.0), met inclusion criteria. Spondylolisthesis slip percentage increased in 55.4% (31/56) of patients. Slip percentage increased significantly (p = 0.002) from baseline (mean 17.2; SD 8.0) to follow-up (mean 20.1; SD 9.6). A logistic regression model identified that females were more likely to have progressive slips compared to males (odd ratio 6.09, 95% CI 1.77-21.01; p = 0.004). ODI scores and spondylolisthesis slip percentage did not correlate at baseline (r = 0.0170; p = 0.90) nor follow-up (r = 0.094; p = 0.49). There was no correlation between the change in ODI scores and change in slip percentage from baseline to final follow-up (r = 0.0474; p = 0.73). Of the 31 patients with slip progression, there was no difference in mean ODI score changes (p = 0.91) for those with 1-5% progression (13/31 [41.9%]; - 18.0 [SD 19.7]) compared to those with > 5% slip progression (18/31 [58.1%]; - 18.7 [SD 16.4]). CONCLUSIONS: Despite a small degree of slip progression in the majority of patients, there was no correlation with symptom worsening, as measured by the ODI. These slides can be retrieved under Electronic Supplementary Material.
Authors: Matthew D Alvin; Daniel Lubelski; Kalil G Abdullah; Robert G Whitmore; Edward C Benzel; Thomas E Mroz Journal: Clin Spine Surg Date: 2016-03 Impact factor: 1.876
Authors: Y Raja Rampersaud; Charles Fisher; Albert Yee; Marcel F Dvorak; Joel Finkelstein; Eugene Wai; Edward Abraham; Stephen J Lewis; David Alexander; William Oxner Journal: Can J Surg Date: 2014-08 Impact factor: 2.089
Authors: Michael C Gerling; Dante Leven; Peter G Passias; Virginie Lafage; Kristina Bianco; Alexandra Lee; Tamara S Morgan; Jon D Lurie; Tor D Tosteson; Wenyan Zhao; Kevin F Spratt; Kristen Radcliff; Thomas J Errico Journal: Spine (Phila Pa 1976) Date: 2017-10-15 Impact factor: 3.241