Gerling MC, et al. - This study investigated the factors that confer risk for reoperation for degenerative spondylolisthesis (DS) and compared outcomes between patients who underwent reoperation with nonreoperative patients. For those who were operated on for DS, 22% incidence of reoperation was reported 8 years following surgery. Risk factors for reoperation included a history of no neurogenic claudication and antidepressants intake. In addition, nonreoperative patients exhibited more favorable outcome scores and treatment effect (TE).

Methods

• This study included patients with neurogenic claudication (>12 weeks), clinical neurological signs, spinal stenosis, and DS on standing lateral x-rays.
• Patient characteristics and risk factors were identified using univariate and multivariate analyses.
• In addition, treatment effects (TEs) were calculated and compared between study groups.

Results

• Data reported that out of 406 patients, 72% underwent instrumented fusion, 21% noninstrumented fusion, and 7% decompression alone.
• Findings demonstrated that at 8 years, the reoperation rate was 22%, of which 28% occurred within 1 year, 54% within 2 years, 70% within 4 years, and 86% within 6 years.
• Researchers observed that recurrent stenosis or progressive spondylolisthesis (45%), complications such as hematoma, dehiscence, or infection (36%), or new condition (14%) were the reasons for reoperation.
• They noted that reoperative patients were younger (62.2 vs. 65.3, P = 0.008).
• Use of antidepressants (P = 0.008, hazard ratio [HR] 2.08) or having no neurogenic claudication upon enrollment (P = 0.02, HR 1.82) were identified as significant risk factors.
• No greater risk for reoperation was reported for patients who were smokers, diabetics, obese, or on workman's compensation.
• Findings also revealed that at 8-year follow-up, nonreoperative patients had better scores for SF-36 bodily pain (BP), Oswestry Disability Index, American Academy of Orthopaedic Surgeons/Modems version (ODI), and stenosis frequency index.
• In addition, it was demonstrated that TE favored nonreoperative patients for SF-36 BP, physical function, ODI, Stenosis Bothersomeness Index, and satisfaction with symptoms (P < 0.001).