Fusion preference profile among AO Spine members for degenerative lumbar spondylolisthesis. Insights for AO Spine KF Degen Spondylolisthesis Survey

Introduction: Surgical approaches when clinically required for lumbar degenerative spondylolisthesis in the real world is not consistent with randomized controlled trials and big data registries that indicate the superiority of decompression over fusion in controlled setting. This study analyzes the fusion preference-profile among the AO spine members to a given case of lumbar degenerative spondylolisthesis. Methods: A survey was distributed online to over 6000 AO Spine members between July 27 – September 8, 2023. Surgeons were presented a case of L4-L5 grade I degenerative spondylolisthesis in a middle aged individual with significant back and leg pain with neurological deficits with radiological dynamic translation without canal stenosis. The participants were queried about their treatment choices for decompression and their decision to offer fusion. Data that may impact that decision were collected that include age, region of practice, training background, years of experience, practice setting, case volume, and their final treatment decisions. Comparative analysis of the responder characteristics was performed using Pearson’s chi-squared test. Results: A total of 943 surgeons responded and 479 completed the survey. We noted a comparable distribution of the responder demographics across age, region of practice, training background, years of experience, practice setting, and case volume. 91% of surgeons opted for fusion in their management, while 9% chose direct decompression alone. Of 429 responders those who opted for fusion procedure, 56% surgeons employed direct decompression techniques while 44% chose indirect decompression resulting from instrumentation. We noted that surgeons with fellowship training (p < 0.05) and higher case load surgeons (p < 0.05) had significantly higher inclination towards fusion. Conclusion: Fusion is commonly employed in the treatment decision combined with decompression in the management of degenerative spondylolisthesis. Surgeons choice of fusion in this setting needs to be systematically studied, as there is a disconnect with the available data from the randomized clinical trials in the field.