Introduction

Determining the impact of systemic health on surgical recovery is vital for risk stratification in spine care. A recent Spine CORe™ analysis examined spondylolisthesis surgery outcomes among patients with varying systemic illness severities. Specifically, the study sought to understand if patients with higher American Society of Anesthesiologists (ASA) classes maintain significant functional improvements five years postoperatively. Therefore, clinicians can better advise patients with complex comorbidities about the potential long-term success of surgical interventions.

Study Methodology and Patient Demographics

Researchers conducted a retrospective analysis using data from the Quality Outcomes Database (QOD) spondylolisthesis registry. The cohort included 328 patients who underwent surgery for grade 2 degenerative lumbar spondylolisthesis across 14 sites. The team categorized patients into two groups: low ASA class (I or II) and high ASA class (III or IV). Furthermore, they collected baseline demographics, including age, BMI, and mental health comorbidities. The primary outcome measures were the Oswestry Disability Index (ODI) and EQ-5D scores, tracked at intervals up to 60 months.

The analysis revealed that the high ASA group was significantly older and had a higher mean BMI than the low ASA group. Additionally, patients in the high ASA category were more likely to have pre-existing conditions such as diabetes, anxiety, and depression. Despite these baseline differences, the researchers prioritized assessing how these factors influenced the final surgical results.

Long-Term Spondylolisthesis Surgery Outcomes

The results demonstrated that both groups experienced substantial and sustained improvements in disability and quality of life. Specifically, spondylolisthesis surgery outcomes remained positive through the five-year follow-up period for all patients. Multiple linear regression analysis confirmed that the ASA class did not significantly predict the postoperative change in patient-reported outcome measures. Consequently, patients with significant systemic illness benefited just as much from the procedure as their healthier counterparts.

Moreover, the follow-up rate at five years was approximately 80%, providing robust evidence for these findings. While high ASA patients started with worse baseline scores, their trajectory of improvement mirrored that of the low ASA group. Thus, systemic illness severity alone should not disqualify patients from receiving surgical treatment for grade 2 spondylolisthesis.

Clinical Implications

This study reinforces the value of spinal surgery in older, more medically complex populations. Although surgeons must remain vigilant regarding perioperative risks in high ASA patients, the expectation of long-term functional gain remains high. Ultimately, the decision for surgery should rest on a comprehensive evaluation rather than a single classification score. This ensures that patients with severe symptoms receive the necessary care to improve their long-term quality of life.

Frequently Asked Questions

Does a high ASA score mean a poor outcome after spine surgery?

No. Research indicates that while patients with higher ASA scores may have more comorbidities, they achieve similar functional improvements and sustained benefits five years after surgery for grade 2 spondylolisthesis compared to healthier patients.

What were the primary outcomes measured in this study?

The study primarily measured the Oswestry Disability Index (ODI) for disability and EQ-5D scores for quality of life to assess long-term recovery and surgical success.

Are older patients with more comorbidities suitable for spondylolisthesis surgery?

Yes. The study shows that older patients and those with high BMIs or diabetes still experience significant and sustained benefits from surgery, suggesting that systemic illness should not be a sole reason to avoid the procedure.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider for any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Harbert AL et al. Do patients with high ASA classes have sustained benefit 5 years after surgery for grade 2 spondylolisthesis? A Spine CORe™ analysis of QOD data. Neurosurg Focus. 2026 May 01. doi: 10.3171/2025.12.FOCUS25959. PMID: 42066372.