Clinical Study| Volume 23, ISSUE 6, P799-804, June 2023

Download started.


Factors influencing the long-term outcomes of instrumentation surgery for degenerative lumbar spondylolisthesis: a post-hoc analysis of a prospective randomized study

Published:February 10, 2023DOI:



      Lumbar spinal canal stenosis caused by degenerative lumbar spondylolisthesis is one of the most common indications for spinal surgery. However, the factors that influence its long-term (>10 years) outcomes remain unknown.


      This is a post-hoc analysis of a prospective randomized study.


      This study aimed to determine factors that influence the long-term outcomes of instrumentation surgery for lumbar spinal canal stenosis due to degenerative lumbar spondylolisthesis.


      Patients aged ≤75 years with single L4/5 level lumbar canal stenosis caused by degenerative lumbar spondylolisthesis prospectively underwent instrumentation surgery at two hospitals between May 1, 2003, and April 30, 2012; the final follow-up examination was on May 20, 2021.


      The following data were collected: modified Japanese Orthopedic Association (JOA) score, JOA score recovery rate, visual analog scale (VAS) score for lower back and leg pain, and scores from eight short-form 36 (SF-36) subscales preoperatively and at the final follow-up examination.


      Spearman's correlation analysis and univariate and multivariate regression analyses were used to examine preoperative factors that affect the JOA score recovery rate in patients who underwent instrumentation surgery for lumbar spinal canal stenosis at the L4/5 level due to degenerative lumbar spondylolisthesis.


      A total of 42 patients who underwent instrumentation surgery for degenerative lumbar spondylolisthesis and had a long-term follow-up period were included. Of these, 25 and 17 underwent posterolateral fusion and Graf stabilization, respectively. The mean postoperative follow-up duration was 12.5 years. Spearman's correlation analysis revealed that the long-term recovery rate was correlated with the preoperative VAS score for low back pain. In the univariate regression analysis, sex, preoperative VAS score for low back pain, and the SF-36 general health score were significantly associated with the long-term recovery rate. Meanwhile, the multiple stepwise regression analysis identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate.


      This study identified the preoperative VAS score for low back pain as an independent predictor of the long-term recovery rate following instrumentation surgery for degenerative lumbar spondylolisthesis. Therefore, when performing posterolateral fusion or Graf stabilization for degenerative lumbar spondylolisthesis, attention should be paid to the intensity of preoperative low back pain and considerations should be given to whether these procedures can improve the patient's symptoms in the long term.



      GH (general health), JOA (Japanese Orthopedic Association), MH (mental health), PLF (posterolateral fusion), SF (social functioning), SF-36 (short-form 36), VAS (visual analog scale)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Spine Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Yeung CM
        • Schoenfeld AJ
        • Lightsey Mt, H
        • Kang JD
        • Makhni MC.
        Trends in spinal surgery performed by American board of orthopaedic surgery part II candidates (2008 to 2017).
        J Am Acad Orthop Surg. 2021; 29: e563-ee75
        • Deyo RA
        • Mirza SK
        • Martin BI
        • Kreuter W
        • Goodman DC
        • Jarvik JG.
        Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.
        JAMA. 2010; 303: 1259-1265
        • Ponkilainen VT
        • Huttunen TT
        • Neva MH
        • Pekkanen L
        • Repo JP
        • Mattila VM.
        National trends in lumbar spine decompression and fusion surgery in Finland, 1997-2018.
        Acta Orthop. 2021; 92: 199-203
        • Kepler CK
        • Vaccaro AR
        • Hilibrand AS
        • Anderson DG
        • Rihn JA
        • Albert TJ
        • et al.
        National trends in the use of fusion techniques to treat degenerative spondylolisthesis.
        Spine (Phila Pa 1976). 2014; 39: 1584-1589
        • Weinstein JN
        • Lurie JD
        • Tosteson TD
        • Hanscom B
        • Tosteson AN
        • Blood EA
        • et al.
        Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis.
        N Engl J Med. 2007; 356: 2257-2270
        • Mummaneni PV
        • Bydon M
        • Alvi MA
        • Chan AK
        • Glassman SD
        • Foley KT
        • et al.
        Predictive model for long-term patient satisfaction after surgery for grade I degenerative lumbar spondylolisthesis: insights from the Quality Outcomes Database.
        Neurosurg Focus. 2019; 46: E12
        • Lee BH
        • Yang JH
        • Lee HM
        • Park JY
        • Park SE
        • Moon SH.
        Surgical outcome predictor in degenerative lumbar spinal disease based on health related quality of life using Euro-Quality 5 dimensions analysis.
        Yonsei Med J. 2016; 57: 1214-1221
        • Inose H
        • Kato T
        • Onuma H
        • Morishita S
        • Matsukura Y
        • Yuasa M
        • et al.
        Predictive factors affecting surgical outcomes in patients with degenerative lumbar spondylolisthesis.
        Spine (Phila Pa 1976). 2021; 46: 610-616
        • Inose H
        • Kato T
        • Sasaki M
        • Matsukura Y
        • Hirai T
        • Yoshii T
        • et al.
        Comparison of decompression, decompression plus fusion, and decompression plus stabilization: a long-term follow-up of a prospective, randomized study.
        Spine J. 2021; 22: 747-755
        • Briggs M
        • Closs JS.
        A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients.
        J Pain Symptom Manage. 1999; 18: 438-446
        • Fukuhara S
        • Ware Jr., JE
        • Kosinski M
        • Wada S
        • Gandek B
        Psychometric and clinical tests of validity of the Japanese SF-36 Health Survey.
        J Clin Epidemiol. 1998; 51: 1045-1053
        • Hirabayashi K
        • Miyakawa J
        • Satomi K
        • Maruyama T
        • Wakano K.
        Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament.
        Spine (Phila Pa 1976). 1981; 6: 354-364
        • Hosmer Jr DW
        • Lemeshow S
        • Sturdivant RX
        Applied logistic regression.
        John Wiley & Sons, New York2013
        • Grant SW
        • Hickey GL
        • Head SJ.
        Statistical primer: multivariable regression considerations and pitfalls.
        Eur J Cardiothorac Surg. 2019; 55: 179-185
        • Maher C
        • Underwood M
        • Buchbinder R.
        Non-specific low back pain.
        Lancet. 2017; 389: 736-747
        • Kalichman L
        • Kim DH
        • Li L
        • Guermazi A
        • Berkin V
        • Hunter DJ.
        Spondylolysis and spondylolisthesis: prevalence and association with low back pain in the adult community-based population.
        Spine (Phila Pa 1976). 2009; 34: 199-205
        • Denard PJ
        • Holton KF
        • Miller J
        • Fink HA
        • Kado DM
        • Marshall LM
        • et al.
        Back pain, neurogenic symptoms, and physical function in relation to spondylolisthesis among elderly men.
        Spine J. 2010; 10: 865-873
        • Müslüman AM
        • Yılmaz A
        • Cansever T
        • Cavuşoğlu H
        • Colak I
        • Genç HA
        • et al.
        Posterior lumbar interbody fusion versus posterolateral fusion with instrumentation in the treatment of low-grade isthmic spondylolisthesis: midterm clinical outcomes.
        J Neurosurg Spine. 2011; 14: 488-496
        • Yee A
        • Adjei N
        • Do J
        • Ford M
        • Finkelstein J
        Do patient expectations of spinal surgery relate to functional outcome?.
        Clin Orthop Relat Res. 2008; 466: 1154-1161
        • MacLean MA
        • Touchette CJ
        • Han JH
        • Christie SD
        • Pickett GE.
        Gender differences in the surgical management of lumbar degenerative disease: a scoping review.
        J Neurosurg Spine. 2020; : 1-18
        • Peduzzi P
        • Concato J
        • Feinstein AR
        • Holford TR.
        Importance of events per independent variable in proportional hazards regression analysis II. Accuracy and precision of regression estimates.
        J Clin Epidemiol. 1995; 48: 1503-1510
        • Harrell Jr., FE
        • Lee KL
        • Mark DB
        Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors.
        Stat Med. 1996; 15: 361-387;2-4
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        Erlbaum, Hillsdale, NJ1988
        • Onda A
        • Otani K
        • Konno S
        • Kikuchi S.
        Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders.
        J Neurosurg Spine. 2006; 5: 26-32
        • Kanayama M
        • Hashimoto T
        • Shigenobu K
        • Togawa D
        • Oha F.
        A minimum 10-year follow-up of posterior dynamic stabilization using Graf artificial ligament.
        Spine (Phila Pa 1976). 2007; 32: 1992-1996