• William A Abdu, Olivia A Sacks, TostesonAnna N AANAGeisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.Department of Medicine, Dartmouth College, Hanover, New Hampshire.The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hano, Wenyan Zhao, Tor D Tosteson, Tamara S Morgan, Adam Pearson, James N Weinstein, and Jon D Lurie.
• Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire.
• Spine. 2018 Dec 1; 43 (23): 1619-1630.

Study DesignRandomized trial with a concurrent observational cohort study.ObjectiveTo compare 8-year outcomes between surgery and nonoperative care and among different fusion techniques for symptomatic lumbar degenerative spondylolisthesis (DS).Summary Of Background DataSurgical treatment of DS has been shown to be more effective than nonoperative treatment out to 4 years. This study sought to further determine the long-term (8-year) outcomes.MethodsSurgical candidates with DS from 13 centers with at least 12 weeks of symptoms and confirmatory imaging were offered enrollment in a randomized controlled trial (RCT) or observational cohort study (OBS). Treatment consisted of standard decompressive laminectomy (with or without fusion) versus standard nonoperative care. Primary outcome measures were the Short Form-36 (SF-36) bodily pain and physical function scores and the modified Oswestry Disability Index at 6 weeks, 3 months, 6 months, and yearly up to 8 years.ResultsData were obtained for 69% of the randomized cohort and 57% of the observational cohort at the 8-year follow up. Intent-to-treat analyses of the randomized group were limited by high levels of nonadherence to the randomized treatment. As-treated analyses in the randomized and observational groups showed significantly greater improvement in the surgery group on all primary outcome measures at all time points through 8 years. Outcomes were similar among patients treated with uninstrumented posterolateral fusion, instrumented posterolateral fusion, and 360° fusion.ConclusionFor patients with symptomatic DS, patients who received surgery had significantly greater improvements in pain and function compared with nonoperative treatment through 8 years of follow-up. Fusion technique did not affect outcomes.Level Of Evidence1.

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