• Sumedha Singh, Pratyush Shahi, Junho Song, Tejas Subramanian, Kyle Morse, Omri Maayan, Kasra Araghi, Nishtha Singh, Olivia Tuma, Tomoyuki Asada, Maximilian Korsun, Eric Mai, James Dowdell, Evan Sheha, Harvinder Sandhu, Todd Albert, Sheeraz Qureshi, and Sravisht Iyer.
• Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021 USA.
• Spine. 2024 Apr 29.

Study DesignRetrospective cohort.ObjectiveTo identify the predictors of slower and non-improvement following surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).Summary Of Background DataThere is limited evidence regarding clinical and radiological predictors of slower and non-improvement following surgery for L4-5 DLS.MethodsPatients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiological variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.Results233 patients (37% decompression, 63% fusion) were included. At <3 months, high pelvic tilt (PT) (OR 0.92, P 0.02) and depression (OR 0.28, P 0.02) were predictors of MCID non-achievement and GRC non-betterment, respectively. Neither retained significance at >6 months and hence, were identified as predictors of slower improvement. At >6 months, low preoperative VAS leg (OR 1.26, P 0.01) and high facet orientation (OR 0.95, P 0.03) were predictors of MCID non-achievement, high L4-5 slip percentage (OR 0.86, P 0.03) and L5-S1 angular motion (OR 0.78, P 0.01) were predictors of GRC non-betterment, and high preoperative ODI (OR 0.96, P 0.04) was a predictor of PASS non-achievement.ConclusionsHigh PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of non-improvement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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