Sleep Impairment in Grade II Lumbar Spondylolisthesis: A 2-year Analysis of the Quality Outcomes Database (QOD)

Introduction: This study aims to assess the prevalence of sleep impairment and risk factors for post-operative sleep impairment at long term-follow up in patients with grade II spondylolisthesis using the QOD database.

Methods: This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients who underwent arthrodesis for grade II lumbar spondylolisthesis were included. Baseline characteristics and comorbidities were recorded. Pre-operative and 3-, 12-, and 24-month patient reported outcomes (PROs) including NRS Back Pain (NRS-BP), NRS Leg Pain (NRS-LP), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D) scales along with post-operative patient satisfaction using the North American Spine Society (NASS) index were evaluated. Sleep quality was assessed through the ODI sleep component at baseline and 2 years postoperatively. Multivariable logistic regression was performed to identify risk factors for failure to improve sleep impairment 2 years after surgery.

Results: Out of 400 patients with grade II spondylolisthesis, 90.25% (n=361) had some form of sleep impairment at baseline. Patients with sleep impairment reported significantly greater back pain, leg pain and greater disability (ODI) at baseline. At 2-year follow-up, 74.25% (222/299) reported improvement in sleep quality. Patients who reported improvement had significantly higher rates of post operative satisfaction (93.5% vs. 74.3%, p< 0.01), decreased back pain (2.3 vs. 4.8, p< 0.01), decreased leg pain (1.6 vs. 4.4, p< 0.01), and greater EQ5D scores (0.82 vs. 0.68, p< 0.01) at 2 years. Patients who did not improve were significantly older and had significantly higher rates of neurogenic claudication, coronary artery disease, and osteoarthritis at baseline. Multivariable analysis revealed that patients who did not improve were more likely to have neurogenic claudication at baseline [adjusted odds ratio (aOR):2.29].

Conclusion : Most patients with grade II lumbar spondylolisthesis have sleep impairment due to back pain. A majority of patients reported improvement in sleep quality after surgery. Incomplete resolution of sleep impairment may be associated with back pain due to neurogenic claudication at baseline.