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Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability

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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.

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Author notes

  1. Robert A. Ravinsky and Eric J. Crawford contributed equally to this paper.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Arizona College of Medicine - Phoenix, 755 E. McDowell Rd, 2nd Floor, Phoenix, AZ, 85006, USA

    Robert A. Ravinsky

  2. Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, 149 College Street, Room 508-A, Toronto, ON, M5T 1P5, Canada

    Eric J. Crawford, Luke A. Reda & Y. Raja Rampersaud

  3. Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Suite 425, 155 College St, Toronto, ON, M5T 3M7, Canada

    Eric J. Crawford

  4. Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, First Floor, East Wing, Room 1E441, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada

    Y. Raja Rampersaud

  5. Arthritis Program, Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Y. Raja Rampersaud

Authors
  1. Robert A. Ravinsky
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  2. Eric J. Crawford
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  4. Y. Raja Rampersaud
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Corresponding author

Correspondence to Y. Raja Rampersaud.

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Ethical approval

The project received research ethics board approval at the Toronto Western Hospital, University Health Network (Toronto, Canada), which is where the work originated.

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The authors declare that they have no direct conflict of interest. Y.R. Rampersaud is a consultant for and has roylaties from Medtronic.

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Ravinsky, R.A., Crawford, E.J., Reda, L.A. et al. Slip progression in degenerative lumbar spondylolisthesis following minimally invasive decompression surgery is not associated with increased functional disability. Eur Spine J 29, 896–903 (2020). https://doi.org/10.1007/s00586-020-06336-4

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  • DOI: https://doi.org/10.1007/s00586-020-06336-4

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