A Comparative Analysis of Revision Rates in Surgical Treatments for Lumbar Isthmic Spondylolisthesis

Wesley M. Durand, Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Theodore Quan, Department of Orthopaedic Surgery, George Washington University, Washington, DC, USA.
Yesha Parekh, Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
S Tim Yoon, Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA.
Patrick C. Hsieh, Department of Neurosurgery, USC Spine Center, Keck Medical Center of the University of Southern California, Los Angeles, CA, USA.
Hai Le, Department of Orthopaedic Surgery, University of California at Davis, Davis, CA, USA.
Philip K. Louie, Center for Neurosciences and Spine, Virginia Mason Medical Center, Seattle, WA, USA.
Stipe Corluka, Spinal Surgery Division, Department of Traumatology, University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia.
Hardeep Singh, Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
Samuel K. Cho, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Sathish Muthu, Department of Orthopaedic Surgery, Government Medical College Hospital, Karur, India.
Zori Buser, Department of Orthopedic Surgery, Grossman School of Medicine, NYU, New York, NY, USA.
Waeel Hamouda, Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Research, and Teaching Hospitals, Cairo University, Cairo, Egypt.
Andreas K. Demetriades, Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary Edinburgh, Scotland, UK.
Gianluca Vadalà, Departmental Faculty of Medicine and Surgery, Research Unit of Orthopaedic and Trauma Surgery, Università Campus Bio-Medico di Roma, Rome, Italy.
Amit Jain, Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

3-12-2025

Journal

Global spine journal

DOI

10.1177/21925682251326914

Keywords

ALIF; PLF; PLIF; TLIF; isthmic spondylolisthesis; revision surgery; surgical management

Abstract

Study DesignRetrospective Cohort Study.ObjectiveIsthmic spondylolisthesis is frequently encountered in spine surgical practice, though there is a significant variation in surgical management strategies. We sought to evaluate revision rates between patients who underwent anterior-approach lumbar interbody fusion (ALIF) alone, posterolateral fusion (PLF) alone, PLIF/TLIF, and ALIF+PSF.MethodsThis retrospective study utilized a large commercial insurance claims database of patients ≤65 years-old. Patients with isthmic spondylolisthesis who underwent single-level instrumented arthrodesis were included, and those who underwent revision surgery, surgery for deformity, multi-level surgery, or surgery for traumatic, infectious, or neoplastic etiologies were excluded, as determined by ICD-10-CM and CPT codes. Patients were assigned to surgical cohorts of ALIF alone, PLF alone, PLIF/TLIF, and ALIF+PSF based on CPT codes. Additional independent variables included age, sex, decompression at index surgery, and region. The primary outcome was revision arthrodesis or decompression, defined using CPT codes. Kaplan-Meier analysis and Cox Proportional Hazards regression were utilized to assess differences in revision occurrence between cohorts.Results1014 patients who underwent single-level arthrodesis for isthmic spondylolisthesis were included. The mean age was 48.6 years, with a mean follow-up of 637.6 days. The majority of patients underwent PLIF/TLIF (60.6%, n = 614), followed by ALIF+PSF (18.5%, n = 188), PLF alone (14.4%, n = 146), and ALIF alone (6.5%, n = 66). The 5-year revision-rate was 11.0% for all patients in the Kaplan-Meier analysis. In multivariable analysis adjusting for confounding factors, ALIF-alone demonstrated significantly higher occurrence of revision compared to both ALIF+PSF (HR 5.0, P = 0.0026) and PLIF/TLIF (HR 5.8, P < 0.0001) groups. Similarly, PLF alone demonstrated significantly higher occurrence of revision surgery compared to PLIF/TLIF (HR 2.4, P = 0.0379) while other comparisons were not statistically significant.ConclusionsIn this analysis of single-level arthrodesis for isthmic spondylolisthesis, patients who underwent ALIF alone had higher revision rates than those who underwent PLIF/TLIF and ALIF+PSF surgery, and those who underwent PLF alone had higher revision rates than those who underwent PLIF/TLIF. Surgical strategies providing both anterior and posterior column support resulted in lower real-world revision rates.

Department

Orthopaedic Surgery

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