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Determine if herniation morphology based on the Michigan State University Classification is associated with differences in (1) patient-reported outcome measures (or (2) surgical outcomes after a microdiscectomy. Adult patients undergoing single-level microdiscectomy between 2014 and 2021 were identified. Demographics and surgical characteristics were collected through a query search and manual chart review. The Michigan State University classification, which assesses disc herniation laterality (zone A was central, zone B/C was lateral) and degree of extrusion into the central canal (grade 1 was up to 50% of the distance to the intra-facet line, grade >1 was beyond this line), was identified on preoperative MRIs. patient-reported outcome measures were collected at preoperative, 3-month, and 1-year postoperative time points. Of 233 patients, 84 had zone A versus 149 zone B/C herniations while 76 had grade 1 disc extrusion and 157 had >1 grade. There was no difference in surgical outcomes between groups (P > 0.05). Patients with extrusion grade >1 were found to have lower Physical Component Score at baseline. On bivariate and multivariable logistic regression analysis, extrusion grade >1 was a significant independent predictor of greater improvement in Physical Component Score at three months (estimate = 7.957; CI: 4.443–11.471, P < 0.001), but not at 1 year. Although all patients were found to improve after microdiscectomy, patients with disc herniations extending further posteriorly reported lower preoperative physical function but experienced significantly greater improvement three months after surgery. However, improvement in Visual Analog Scale Leg and back, ODI, and MCS at three and twelve months was unrelated to laterality or depth of disc herniation. [ABSTRACT FROM AUTHOR]

To compare patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for time to minimum clinically important difference (MCID) achievement and predictors of delayed MCID achievement for the patient-reported outcomes (PROs), Patient-Reported Outcomes Measurement Information System Physical Function, Neck Disability Index, Visual Analog Scale (VAS) neck, and VAS arm. PROs of patients undergoing ACDF or CDR were collected preoperatively and postoperatively at 6-week/12-week/6-month/1-year/2-year periods. MCID achievement was calculated through comparison of changes in Patient-Reported Outcomes Measurement to previously established values in literature. Time to MCID achievement and predictors for delayed MCID achievement were determined through Kaplan-Meier survival analysis and multivariable Cox regression, respectively. One hundred ninety-seven patients were identified, with 118 and 79 undergoing ACDF and CDR, respectively. Kaplan-Meier survival analysis demonstrated faster time to achieve MCID for CDR patients in Patient-Reported Outcomes Measurement Information System Physical Function (P = 0.006). Early predictors of MCID achievement through Cox regression were CDR procedure, Asian ethnicity, elevated preoperative PROs of VAS neck and VAS arm (hazard ratio, 1.16–7.28). Workers' compensation was a late predictor of MCID achievement (hazard ratio, 0.15). Most patients achieved MCID in physical function, disability, and back pain outcomes within 2 years of surgery. Patients undergoing CDR achieved MCID faster in physical function. Early predictors of MCID achievement were CDR procedure, Asian ethnicity, and elevated preoperative PROs of pain outcomes. Workers' compensation was a late predictor. These findings may be helpful in managing patient expectations. [ABSTRACT FROM AUTHOR]

To evaluate the influence of symptom duration before anterior cervical discectomy and fusion (ACDF) on patient-reported outcomes (PROs) in workers' compensation patients. A prospective registry was searched for workers' compensation patients who underwent ACDF for herniated disc. Two cohorts based on symptom duration were formed: lesser duration (LD) (<6 months) and prolonged duration (PD) (≥6 months). PROs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. PROs were compared within and between groups. Rates of minimum clinically important difference (MCID) were compared between groups. The study included 63 patients. The LD cohort reported improvement in Patient-Reported Outcomes Measurement Information System–Physical Function (PROMIS-PF), Neck Disability Index (NDI), and visual analog scale (VAS) neck at 12 weeks and 6 months and VAS arm at all periods (all P ≤ 0.036). The LD cohort reported improvement in NDI at 12 weeks and 6 months and VAS arm at 6 weeks, 12 weeks, and 6 months (all P ≤ 0.037). Between groups, the LD cohort demonstrated superior scores in PROMIS-PF at 6 weeks, 12 weeks, and 6 months; NDI preoperatively and at 6 weeks, 12 weeks, and 6 months; VAS neck at 12 weeks; and 9-item Patient Health Questionnaire (PHQ-9) at 6 months (all P ≤ 0.045). The LD group was more likely to achieve MCID in PROMIS-PF at 12 weeks (P = 0.012). The PD group was more likely to achieve MCID in PHQ-9 at 6 months (P = 0.023). Regardless of length of symptom duration before ACDF in workers' compensation patients, the patients demonstrated improvements in disability and arm pain. Patients with LD also demonstrated improvements in physical function and neck pain. Patients with LD demonstrated superior scores in physical function, pain, disability, and mental health and were more likely to achieve clinically significant improvement in physical function. Patients with PD were more likely to achieve clinically significant improvement in mental health. [ABSTRACT FROM AUTHOR]

To introduce a new technique for retraction in lumbar microdiscectomy, the rubber band technique (RT), and compare 1-year clinical outcomes of the technique with standard microdiscectomy (SM). In this retrospective analysis, 81 consecutive patients with single-level lumbar disc herniation underwent lumbar microdiscectomy by either RT or SM. The primary outcome was Oswestry Disability Index score 1 year after surgery. Secondary outcomes included Short-Form Health Survey (SF-36) physical functioning subscale score, SF-36 bodily pain subscale score, and visual analog scale back pain and leg pain scores. Other parameters were operative time, hospital stay, skin incision, complications, and redo surgery. Of 81 patients, 93% (76 patients) had complete data up to 1-year follow up. The RT group comprised 39 patients (20 males, 19 females), and the SM group comprised 37 patients (19 males 18 females). Primary and secondary outcomes Oswestry Disability Index score, SF-36 physical functioning score, SF-36 bodily pain score, VAS back and leg pain scores, complications, and redo surgery did not differ significantly between the treatment groups at follow-up points (P > 0.05). Skin incision was smaller in the RT group compared with the SM group (P = 0.0001). Over the 1-year follow-up period, clinical outcomes of patients treated with RT were comparable to patients treated with SM. RT appears to be an alternative safe, effective, and economical approach for lumbar microdiscectomy. [ABSTRACT FROM AUTHOR]

To compare patient-reported outcome measure (PROM) scores and minimum clinically important difference (MCID) achievement rates among patients undergoing single-level anterior cervical discectomy and fusion (ACDF) in patients with varying severity of preoperative visual analog scale (VAS) neck score. Patients with ACDF were grouped: severity of preoperative VAS neck score ≤8 or >8. Demographic/perioperative variables and PROMs (Patient-Reported Outcomes Measurement Information System Physical Function [PROMIS PF] score, 12-Item Short Form [SF-12] Mental Component Score [MCS], VAS neck/arm score, and Neck Disability Index [NDI]) were collected preoperatively/postoperatively. MCID attainment comparison by grouping was evaluated using χ2 analysis. A total of 137 patients were included (103 VAS neck preoperative score ≤8; 34 VAS neck preoperative score >8). The VAS neck preoperative score ≤8 cohort did not improve: 6 weeks PROMIS-PF score, 6 weeks SF-12 Physical Component Score [PCS], 12 weeks/1 year/2 years SF-12 MCS, 2 years VAS neck score, and 1 years/2 years VAS arm score (P ≤ 0.015, all). VAS neck preoperative score >8 did not improve: 6 weeks/12 weeks/2 years PROMIS-PF score, all time points SF-12 PCS, 6 weeks/12 weeks/1 year/2 years SF-12 MCS, and 2 years VAS arm score (P ≤ 0.013, all). VAS neck preoperative score >8 had inferior PROMIS-PF scores all time points except 1 year (P ≤ 0.036, all), lower SF-12 PCS 6 weeks/6 months (P ≤ 0.043, both), inferior SF-12 MCS at preoperative to 6 months (P ≤ 006, all), higher VAS neck score from preoperative to 6 months (P ≤ 0.018), higher VAS arm score preoperative/12 weeks/6 months (P ≤ 0.020, all), and higher NDI at preoperative/12 weeks/6 months (P ≤ 0.030, all). MCID attainment rates for VAS neck preoperative score >8 were greater for NDI 2 years (P = 0.040), lower for PROMIS-PF score 2 years, and overall (P = 0.018), lower for SF-12 MCS 12 weeks (P = 0.046), lower for VAS neck score 12 weeks to 1 year and overall (P ≤ 0.032, all), and lower for VAS arm score 6 weeks/1 year (P ≤ 0.030, both). Patients with single-level ACDF presenting with greater baseline neck pain showed poorer physical function/pain/disability/mental health at preoperative/intermediate postoperative time points, but had comparable long-term PROMs by 2 years. MCID attainment was lower among patients with greater preoperative neck pain; MCID among the VAS neck score >8 cohort were only significantly inferior for neck pain. [ABSTRACT FROM AUTHOR]

To determine whether operative duration of anterior cervical discectomy and fusion (ACDF) significantly affects patient-reported outcome measures (PROMs) 90 days after surgery and at 1-year follow-up. Patients who underwent primary 1-level to 4-level ACDF were retrospectively identified. Demographic data and PROMs were collected through chart review. Patients were split into short, medium, and long tertiles based on procedure duration. PROM surveys were administered preoperatively as baseline measurements, at initial follow-up (between 60 and 120 days postoperatively), and at 1 year postoperatively. Outcomes included Neck Disability Index, Short-Form 12 Physical Component Score (PCS-12), Short-Form 12 Mental Component Score, visual analog scale (VAS) neck score, and VAS arm score. Significant short-term improvements were found across all groups for all PROMs. All groups showed long-term improvements in Short-Form 12 Mental Component Score, PCS-12, Neck Disability Index, VAS neck score, and VAS arm score, with the exception of the medium-duration group in PCS-12 (P = 0.093). On multivariate analysis, short-duration procedures predicted better improvement in VAS neck score (β = –1.01; P = 0.012) and VAS arm score (β = –1.38; P = 0.002) compared with long-duration procedures, whereas medium-duration procedures resulted in better improvement in VAS arm score (β = –1.00; P = 0.011). Further, short and medium duration was a predictor of decreased length of hospital stay (β = –0.67, P = 0.001 and β = –0.59, P = 0.001, respectively) compared with long-duration procedures. All groups improved after ACDF regardless of surgical duration. Further, surgical duration was not a predictor of differing improvement in physical function or disability. [ABSTRACT FROM AUTHOR]

To compare perioperative characteristics, patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement after anterior cervical discectomy and fusion (ACDF) in patients stratified by preoperative neck disability. The Neck Disability Index (NDI) assesses a patient's self-perceived neck disability and is often used to assess the efficacy of cervical surgical intervention. Our study (a retrospective cohort study) evaluates how preoperative severity of patient neck disability influences postoperative clinical improvement after ACDF. Primary, single-level, or multilevel ACDF procedures were included. PROMs were administered at preoperative/6 week/12 week/6 month/1 year/2 year time points and included Patient-Reported Outcome Measurement Information System–Physical Function (PROMIS-PF), visual analog scale (VAS) for neck and arm pain, NDI, and 12-Item Short-Form (SF-12) Physical Composite Score (PCS). Patients were grouped according to preoperative NDI <50 (mild to moderate neck disability) or NDI ≥50 (severe neck disability). Demographics/perioperative characteristics/postoperative complications/mean PROMs/MCID achievement rates were compared using χ2 or Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired-samples t test. MCID achievement was determined by comparing ΔPROMs with established thresholds. A total of 225 patients were included, 150 NDI <50 and 75 NDI ≥50. The NDI ≥50 cohort was significantly younger (P = 0.002). Cohorts did not differ for spinal disease/operative duration/estimated blood loss/postoperative length of stay/postoperative narcotic consumption/adjacent segment disease rate/1-year arthrodesis rate/6-month pseudarthrosis rate. Postoperative VAS pain score on postoperative day 0 and 1 was significantly increased in the NDI ≥50 cohort (P < 0.048, all). Postoperative complication rates did not differ. All mean PROMs differed at all time points (P < 0.043, all). The NDI <50 patient cohort significantly improved from preoperative baseline for all PROMs and time points except SF-12 PCS/Patient-Reported Outcome Measurement Information System–Physical Function at 6 weeks. The NDI ≥50 cohort significantly improved for all PROMs and time points except SF-12 PCS at 6 weeks. The NDI ≥50 cohort showed a greater proportion achieving MCID for NDI at 6 weeks/2 years/overall (P < 0.037, all). Both cohorts showed significant long-term clinical improvement for neck pain/arm pain/physical function/neck disability, although patients with severe preoperative neck disability reported inferior mean scores for these outcomes at all time points. [ABSTRACT FROM AUTHOR]

To assess differences in postoperative patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) attainment following single-level anterior cervical discectomy and fusion based on predominant preoperative pain symptom. Patients undergoing primary, single-level anterior cervical discectomy and fusion were identified. PROMs included visual analog scale (VAS) arm and neck, 12-item short-form physical component summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), and Neck Disability Index, collected preoperatively and postoperatively. Patients were placed in preoperative predominant arm pain (pAP) and preoperative predominant neck pain groups. χ2 test compared demographic and perioperative characteristics, and MCID attainment rates. Student t test evaluated change from preoperative to postoperative PROM values and compared PROMs between groups. There were 110 patients assessed (52 neck pain, 58 arm pain). Patients with preoperative predominant neck pain improved significantly from preoperative to postoperative at 12 weeks to 1 year for PROMIS-PF, 6 months and 1 year for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 6 months for VAS arm, and 6 weeks to 2 years for Neck Disability Index (all P ≤ 0.035). Patients with pAP improved significantly from preoperative to all postoperative time points for PROMIS-PF, 6 months to 2 years for SF-12 PCS, 6 weeks to 1 year for VAS neck, 6 weeks to 1 year for VAS arm, and 6 weeks to 6 months for Neck Disability Index (all P ≤ 0.040). Mean PROMIS-PF was higher at 6 weeks, preoperative VAS neck was lower, and preoperative VAS arm was higher for pAP patients (all P ≤ 0.013). MCID attainment was significantly higher in pAP patients for PROMIS-PF from 6 weeks to 6 months, SF-12 PCS 6 weeks, and VAS arm 12 weeks. Predominant pain symptom demonstrated little effect on perioperative characteristics and postoperative PROMs. Anterior cervical discectomy and fusion candidates will likely experience similar clinically meaningful postoperative improvements in physical function, disability, and pain. [ABSTRACT FROM AUTHOR]

Although the Veterans RAND 12-item Physical Component Survey (VR-12 PCS) has been broadly used to evaluate patient-reported outcome measures (PROMs) in spine surgery, its feasibility for use in patients undergoing minimally invasive lumbar discectomy (MIS LD) has not been well studied. This study aimed to assess the feasibility of VR-12 PCS for use up to 2 years postoperatively for MIS LD by correlation with PROMs for physical function. Patients undergoing primary single-level MIS LD procedures were reviewed retrospectively. Results on the VR-12 PCS, 12-Item Short Form (SF-12) PCS, and Patient-Reported Outcomes Measurement Information System (PROMIS PF) were recorded preoperatively and up to 2 years postoperatively. Improvements in postoperative PROMs were calculated and assessed for significant differences from baseline values. Correlation significance and strength were evaluated between VR-12 PCS and SF-12 PCS or PROMIS PF. Scatterplots were constructed to demonstrate relationships of VR-12 PCS with SF-12 PCS and PROMIS PF at each time point. Our cohort comprised 402 patients. Patients improved significantly from preoperative baseline for all 3 PROMs at all postoperative time points. Both Pearson's correlation and time-independent partial correlation revealed statistically significant strong correlations of VR-12 PCS with SF-12 PCS and PROMIS PF through 2-years. Physical function scores for VR-12, SF-12, and PROMIS PF all demonstrated significant improvements following MIS LD. Strongly statistically significant correlations of VR-12 PCS with SF-12 PCS and PROMIS PF from preoperative measures through 2 years demonstrate the feasibility of VR-12 for assessing patient-reported physical function in MIS LD patients. [ABSTRACT FROM AUTHOR]

To introduce a newly designed periendoscopic visualized trephine system for foraminoplasty in treating lumbar disc herniation with migration and/or foraminal or lateral recess stenosis, and report early clinical outcomes evaluated by the Patient-Reported Outcomes Measurement Information System (PROMIS). A total of 25 patients who underwent transforaminal endoscopic lumbar discectomy with foraminoplasty using a periendoscopic visualized trephine from June 2019 to January 2020 were retrospectively reviewed. PROMIS pain interference and physical function were selected as outcome measures. The average age of the 25 patients (16 males, 9 females) was 32.0 ± 7.5 years (20–48 years). All patients were successfully followed up with the mean time of 10.1 ± 2.8 months (6–12 months). PROMIS pain interference scores decreased significantly from mean 67.0 ± 3.4 preoperatively to 37.5 ± 5.4 at the final follow-up (P < 0.01), and PROMIS physical function scores improved significantly from mean 29.2 ± 5.5 preoperatively to 59.3 ± 3.7 at the final follow-up (P < 0.01). No neural or vascular complication occurred. Full endoscopic lumbar foraminoplasty with a periendoscopic visualized trephine technique is safe and effective for treating lumbar disc herniation with migration and/or lateral recess or foraminal stenosis, with improved flexibility and convenience and decreased radiation exposure. [ABSTRACT FROM AUTHOR]