Is surgery associated with improvement of sleep disturbance in patients with grade 2 lumbar spondylolisthesis? Insights from the Spine CORe™ analysis of QOD data

OBJECTIVE: The authors aimed to evaluate the prevalence of sleep disturbance in patients with grade 2 lumbar spondylolisthesis and assess postoperative trajectories and predictors of improvement at 5 years. They hypothesized that surgical treatment of grade 2 spondylolisthesis would result in high rates of long-term improvement in sleep disturbance. METHODS: Patients with grade 2 lumbar spondylolisthesis were identified from the 14-site Spine CORe™ study group within the Quality Outcomes Database (QOD). Sleep disturbance was measured using the sleep item of the Oswestry Disability Index (ODI) at baseline and 3, 12, 24, and 60 months postoperatively. The prevalence of baseline sleep disturbance was determined. Clinically meaningful improvement was defined using minimal clinically important difference thresholds. Predictors of improvement were analyzed using multivariate Firth's logistic regression, and associations with pain, disability, quality of life, and satisfaction were assessed. RESULTS: A total of 328 patients underwent surgery for grade 2 spondylolisthesis. At baseline, 300 of 328 patients (91.5%) reported sleep disturbance. The 60-month follow-up rate in this subgroup was 81% (21 died within 5 years of surgery of unrelated causes and 223 of the 300 patients followed up at 5 years). Improvement in sleep disturbance was observed in 165 patients (74.0%), while 58 patients (26.0%) continued to report sleep disturbance at 60 months. Those with improved sleep were more likely to achieve clinically meaningful gains in back pain (80.5% vs 50.0%, p < 0.001), leg pain (83.6% vs 53.4%, p < 0.001), EQ-5D (31.1% vs 7.3%, p < 0.001), and ODI (62.8% vs 5.3%, p < 0.001) scores, with a trend toward higher satisfaction in patients with improved sleep (88.5% vs 77.8%; risk difference 10.7%, 95% CI -0.01 to 0.23). On multivariate analysis, only private insurance (OR 2.20, 95% CI 1.03-4.78; p = 0.041) was associated with greater odds of 60-month sleep improvement. CONCLUSIONS: Sleep disturbance was highly prevalent in 91.5% of patients with grade 2 spondylolisthesis, and 74.0% experienced meaningful improvement by 3 months and this was sustained for 5 years following surgery. Sleep recovery was closely tied to gains in pain, disability, and quality of life. These results demonstrate that surgery for grade 2 spondylolisthesis not only improves mechanical symptoms but also substantially alleviates sleep disturbance.