Mummaneni Award - Does Back Pain Catastrophizing Influence 5-year Surgical Outcomes for Patients with Degenerative Lumbar Spondylolisthesis? A Quality Outcomes Database Study

Introduction: Degenerative lumbar spondylolisthesis is an important cause of back pain—influenced by multiple factors including instability, disc degeneration, facet arthropathy, paraspinal radiculopathy, and psychosocial phenotype. The experience of high-severity pain is complex, with significant implications for surgical planning.

Methods: Using the prospective Quality Outcomes Database cohort, patients undergoing single-segment surgery for grade 1 degenerative lumbar spondylolisthesis were stratified by baseline back pain (NRS-BP >=8 as "severe" and < 8 as "mild-moderate"). Patient-reported outcomes (PROs) were compared at 60-months postoperatively, with multivariate analysis adjusting for variables reaching p< 0.20 on univariate.

Results: Of 608 patients, 487 (80%) reached 60-month follow-up. 260 (42.8%) had severe, and 348 (57.2%) had mild-moderate back pain at baseline. Patients with severe back pain were significantly younger (59.9±2.2 vs 63.9±11.7,p < 0.001), less often had ≥4 years college education (31.2% vs 42.5%,p=0.004), and more often used private insurance (58.8% vs 47.7%,p=0.01). The severe-pain cohort had higher rates of depression (24.6% vs 17.0%,p=0.02) and back pain symptom predominance (45.4% vs 32.2%,p < 0.001). Procedural and perioperative characteristics did not significantly differ between cohorts. The severe-pain cohort reported worse PROs at baseline and 60 months, but showed significantly greater 60-month improvement for all PROs (p < 0.005) when compared to the mild-moderate cohort. Achievement of MCID was also significantly greater across PROs (p < 0.05), though 60-month NASS satisfaction was not significantly different between cohorts. Multivariate analysis found severe back pain to significantly predict 60-month NRS-BP change (OR=–1.44; 95% CI –1.80 to –1.08; p< 0.001) and MCID achievement (OR=1.94; 95% CI 1.50 to 2.53; p< 0.001), but not mean NRS-BP or other PRO metrics.

Conclusion : Patients with severe back pain achieved substantially greater 60-month NRS-BP improvement and MCID achievement from surgery, though patient satisfaction was comparable to the mild-moderate cohort. Our findings highlight the importance of expectation setting for patients with severe preoperative pain on the potential for substantial improvement, albeit with residual symptoms.