Are Patients with Severe Pain Ideal Candidates for Minimally Invasive Surgery for Degenerative Lumbar Spondylolisthesis? A QOD Analysis

Introduction: MIS is increasingly being used during surgical treatment of degenerative lumbar spondylolisthesis, though certain subpopulations may benefit more from MIS approaches. Our study aims to identify long-term outcomes of MIS across multiple follow-up time points in a cohort with severe baseline pain.

Methods: Within the Quality Outcomes Database Lumbar Spondylolisthesis prospective dataset, patients with severe baseline pain were defined as Numeric Rating Scale Back Pain (NRSLP) or Leg Pain (NRSLP) ≥7. MIS included decompression, percutaneous pedicle screw placement with anterior/lateral interbody, or TLIF. Univariate and multivariable analysis was performed on 2-year and 5-year PROs, multivariate controlling for covariates with p< 0.05.

Results: Of the 455 patients with severe baseline pain, 257 (56.5%) received open surgery and 198 (43.5%) received MIS. 5-year follow-up rates were equivalent (MIS:81.9% vs Open:78.8%, p=0.35). Those receiving MIS were significantly older (63.0±11.6 vs 59.9±12.3, p=0.005) and more likely to be highly educated (39.9% vs 30.7%, p=0.042). Baseline PROs were similar across cohorts (p>0.05). MIS patients had shorter hospitalization (2.5±2.0 vs 3.1±1.6, p=0.001) and lower estimated blood loss (110.2±102.2 vs 256.2±238.0, p<;0.001). On multivariate analysis, MIS was significantly associated with a 2-year change in ODI (Beta=-4.17, CI -8.27 to -0.063, p=0.047), though this superiority was no longer seen with 5-year change in ODI (Beta=-3.31, CI -7.83 to 1.20, p=0.15). There were no differences in 2- and 5-year changes in NRSBP or NRSLP (p>0.05).

Conclusion : Among patients with severe pain operated for degenerative lumbar spondylolisthesis, MIS approaches were associated with less blood loss and shorter hospital stays. MIS approaches were associated with a modestly superior ODI 2 years postoperatively—but not 5 years postoperatively. Both approaches improved back and leg pain similarly. Our findings suggest that amongst patients with severe pain, MIS is a somewhat superior procedure for disability in the first several years following surgery, but advantages may fade longer term.