Objective:

Our study compares patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement following anterior or transforaminal lumbar interbody fusion (ALIF or TLIF) for isthmic spondylolisthesis in patients presenting with predominant back pain versus predominant leg pain symptoms.

Methods:

A single-surgeon database was reviewed for ALIF/TLIF procedures for isthmic spondylolisthesis. Patient demographics, perioperative characteristics, postoperative complications, and PROMs were collected. Demographic/perioperative characteristics were compared among groups using chi-square and Student’s t-test for categorical and continuous variables, respectively. Mean PROM scores were compared utilizing a unpaired Student’s t-test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired samples t-test. MCID achievement rates were compared with chi-squared analysis.

Results:

143 patients were included with 65 patients in the predominant back pain and 78 patients in the predominant leg pain cohort. Preoperative VAS leg was noted to be significantly greater in predominant leg pain cohort (p<0.001)(Table 4). Cohorts demonstrated significant mean postoperative differences for the following PROMs at the following postoperative timepoints: Significant differences were noted between cohorts for rate of achievement of MCID for the following PROMs at the following timepoints: VAS back at 2-years and VAS leg at 6-weeks/12-weeks/6-months/overall (p<0.036, all)(Table 5).

Conclusion:

When compared to patients presenting for surgery with predominant leg pain symptoms, patients undergoing lumbar fusion at L4-L5 and L5-S1 for isthmic spondylolisthesis with predominant back pain symptoms may demonstrate improved long term clinical outcomes for reported back pain, leg pain, and disability and reduced postoperative length of stay and narcotic consumption.