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To compare patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement following anterior or transforaminal lumbar interbody fusion for isthmic spondylolisthesis in patients presenting with predominant back pain versus predominant leg pain symptoms. A single-surgeon database was reviewed for anterior or transforaminal lumbar interbody fusion procedures for isthmic spondylolisthesis. Patient demographics, perioperative characteristics, postoperative complications, and PROMs were collected. Demographic/perioperative characteristics were compared among groups using χ2 and Student t tests for categorical and continuous variables, respectively. Mean PROM scores were compared using an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired-samples t test. MCID achievement rates were compared with χ2 analysis. In total, 143 patients were included with 65 patients in the predominant back pain and 78 patients in the predominant leg pain cohort. Preoperative visual analog scale (VAS) leg was noted to be significantly greater in predominant leg pain cohort (P < 0.001). Cohorts demonstrated significant mean postoperative differences for the following PROMs at the following postoperative time points: significant differences were noted between cohorts for rate of achievement of MCID for the following PROMs at the following time points: VAS back at 2 years and VAS leg at 6 weeks/12 weeks/6 months/overall (P < 0.036, all). Compared with patients presenting for surgery with predominant leg pain symptoms, patients undergoing lumbar fusion at L4–L5 and L5–S1 for isthmic spondylolisthesis with predominant back pain symptoms may demonstrate improved long-term clinical outcomes for reported back pain, leg pain, and disability and reduced postoperative length of stay and narcotic consumption. [ABSTRACT FROM AUTHOR]

To compare perioperative outcomes, patient-reported outcome measures (PROMs), and minimum clinically important difference achievement after single-level transforaminal lumbar interbody fusion (TLIF) in patients stratified by preoperative comorbidity burden. PROMs were administered preoperatively/postoperatively and included Patient-Reported Outcomes Measurement Information System–Physical Function (PROMIS-PF), visual analog scale (VAS), Oswestry Disability Index (ODI), and 12-Item Short-Form Physical Composite Score (SF-12 PCS). Patients were grouped according to preoperative Charlson Comorbidity Index (CCI) <5 (mild to moderate comorbidity) or preoperative CCI ≥5 (severe preoperative comorbidity). A 3:1 propensity score match for age, gender, insurance status, smoking status, and preoperative spinal disease was used to control for significant demographic differences between cohorts. After propensity score matching, 255 patients were included (135 in the CCI <5 cohort; 120 in the CCI ≥5 cohort). The CCI ≥5 cohort showed significantly reduced postoperative VAS back pain score on the day of surgery (P < 0.001, all). Mean PROM differences were noted for postoperative PROMs: VAS back and ODI 6 months, both instances favoring the CCI ≥5 cohort (P < 0.038). The CCI <5 cohort improved from baseline to 1 year for all postoperative PROMs except SF-12 PCS 6 weeks and 12 weeks and SF-12 Mental Composite Score 6 weeks (P < 0.034, all). The CCI ≥5 cohort reported significant improvement from preoperative baseline to 1 year for all postoperative PROMs except ODI 6 weeks, SF-12 Mental Composite Score 6 weeks and 1 year, SF-12 PCS 6 weeks, and PROMIS-PF 6 weeks (P < 0.017, all). Both cohorts reported >50% overall minimum clinically important difference achievement rate for VAS leg, VAS back, ODI, SF-12 PCS, and PROMIS-PF. The results suggest that patients undergoing MIS TLIF with severe comorbidities can expect a similar postoperative trajectory for disability, leg and back pain, and physical function. However, long-term (1 year) mental health improvement from preoperative baseline was noted only in the mild to moderate comorbidity group. [ABSTRACT FROM AUTHOR]

To characterize lateral lumbar interbody fusion surgical learning curve and investigate changes in perioperative and postoperative clinical parameters associated with increased operative experience. In a case series, surgical learning curve was defined using 3-parameter asymptotic regression and piecewise linear regression, yielding learning phase (patients 1–53) and proficient phase (patients 54–179) cohorts. Using a 5-point grading scale, ipsilateral iliopsoas (hip-flexion) and quadriceps (knee-extension) muscle strength and thigh and groin sensory disturbances were compared for differences preoperatively versus postoperatively using χ2 test. Patient-reported outcome measures were collected preoperatively and postoperatively and compared between cohorts with unpaired t test. The proficient phase cohort demonstrated significantly reduced operative time, estimated blood loss, postoperative length of stay, and narcotic consumption on postoperative days 0 and 1. The proficient phase cohort displayed decreased disability at 6 weeks and 6 months and demonstrated significant improvement at all time points for disability, pain, and physical function except for 6 weeks and 2 years for physical function, whereas the learning phase cohort demonstrated improvement in disability beginning at 6 months, leg pain at all time points, and back pain through 6 months. Ipsilateral groin and thigh sensory disturbances and iliopsoas and quadriceps weakness improved with increasing operative experience. The proficient phase cohort demonstrated significantly improved perioperative profile, reduced complication rate, and reduced rates of iliopsoas and quadriceps weakness. While the proficient phase cohort demonstrated earlier improvement in disability and physical function scores compared with the learning phase cohort, 2-year outcome measures did not differ. Long-term clinical outcomes suggest that patient safety and quality of life are not compromised during the learning phase, but patients may be particularly susceptible to femoral nerve injury early in a surgeon's practice. [ABSTRACT FROM AUTHOR]

Our study evaluates minimum clinically important difference (MCID) achievement for back pain/leg pain/disability and meeting preoperative expectations as predictors of patient satisfaction after minimally invasive lumbar decompression (MIS-LD) surgery. Single/multilevel MIS-LD procedures were identified. Patient-reported outcome measures (preoperative/postoperative), expectations (preoperative), and satisfaction (postoperative) were collected for visual analog scale (VAS) back/VAS leg/Oswestry Disability Index (ODI). Student's t -test assessed patient-reported outcome measure improvement from preoperative baseline. Correlations between outcome and satisfaction scores were evaluated using the Pearson correlation coefficient and categorized according to strength of relationship. MCID achievement and meeting expectations were evaluated as predictors of postoperative patient satisfaction with simple linear regression. Comparison of meeting expectations or achieving MCID as predictors of satisfaction scores was performed using a post hoc Suest test comparison of standardized β-coefficients. A total of 329 patients were included. All outcomes improved from baselines (P < 0.001, all) at all postoperative time points and demonstrated strong and negative correlations with satisfaction scores (P < 0.001, all). Majority of patients had their expectations met for ODI/VAS back/VAS leg and achieved MCID for ODI/VAS back/VAS leg at all time points and overall. Both MCID achievement and meeting preoperative expectations demonstrated significant associations with satisfaction scores at all time points for ODI/VAS back/VAS leg. Post hoc analysis of predictors of patient satisfaction in pain and disability demonstrated that MCID achievement was an equivalent predictor to meeting patient preoperative expectations at all postoperative time points. Pain/disability improved after MIS-LD; improvement was strongly correlated with postoperative satisfaction. Meeting expectations/MCID achievement is associated with satisfaction. MCID achievement was equivalent to meeting expectations in predicting satisfaction at all postoperative time points for pain/disability. [ABSTRACT FROM AUTHOR]

To evaluate impact of preoperative mental health on expectations in patients undergoing transforaminal, anterior, or lateral lumbar interbody fusion. Demographics, perioperative characteristics, duration of preoperative symptoms, and preoperative mental health scores were collected. Pain and disability were recorded using preoperative visual analog scale (VAS) for back and leg pain and Oswestry Disability Index scores. Patients' expectations were recorded. Preoperative mental health was recorded using Patient Health Questionnaire-9 (PHQ-9), 12-Item Short Form Health Survey (SF-12) mental component score (MCS), and Veterans RAND 12-Item Health Survey (VR-12) MCS. PHQ-9 scores were categorized by severity of depressive symptoms. Simple linear regression evaluated impact of preoperative mental health on patient expectations for pain and disability; multiple linear regression evaluated the same while accounting for preoperative scores. In 181 patients, PHQ-9 and increasing severity of depressive symptoms significantly predicted VAS back pain expectations (P ≤ 0.006); significance was lost after accounting for preoperative VAS back pain. All mental health outcomes significantly predicted VAS leg pain expectations (P ≤ 0.040); only PHQ-9 retained significance after accounting for preoperative VAS leg pain. All mental health scores significantly predicted ODI expectations (P < 0.001); none retained significance after accounting for preoperative ODI. PHQ-9, SF-12, and VR-12 significantly predicted all ODI domains except personal care and pain intensity (P ≤ 0.045). PHQ-9 significantly predicted patient expectations for lifting, walking, standing, sleeping, sex life, and social life. SF-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, and social life after accounting for preoperative domain scores. VR-12 MCS significantly predicted expectations for lifting, walking, standing, sleeping, sex life, and social life (P ≤0.050, all), even after accounting for preoperative scores. Mental health scores impact expectations regarding improvement in more active areas of a patient's life. Poor mental health scores may be associated with lower expectations for preoperative symptom improvement. [ABSTRACT FROM AUTHOR]

We compared the patient-reported outcomes (PROs), minimal clinically important difference (MCID) achievement, and perceived postoperative satisfaction after minimally invasive lumbar decompression of patients stratified by self-identified gender. Patients who had undergone single minimally invasive lumbar decompression were identified. The PRO measures were administered preoperatively and postoperatively and included the PRO measurement information system–physical function, visual analog scale (VAS) for back and leg pain, Oswestry disability index (ODI), and 12-item short form physical and mental component scores. The patients were grouped by self-identified gender. Propensity score matching was performed. The mean PROs and postoperative satisfaction scores were compared between cohorts using a 2-sample t test. The postoperative PRO improvement within each cohort was calculated using a paired t test. MCID achievement was determined by comparison to previously established threshold values. The MCID achievement rates were compared among the groups using simple logistic regression. A total of 128 propensity score-matched patients were included: 44 in the female group and 84 in the male group. The male group demonstrated worse VAS scores for back pain at 12 weeks and a worse ODI at 6 weeks (P < 0.046 for all). The female cohort had achieved greater rates of a MCID for the ODI at 6 months (P < 0.049). Patients in the self-identified female group demonstrated higher levels of postoperative satisfaction for the VAS score for leg pain at 6 and 12 weeks), the VAS score for back pain at 12 weeks, and the ODI at 6 and 12 weeks (P < 0.028 for all). Additionally, patients in the self-identified female group demonstrated greater levels of satisfaction for lifting at 6 and 12 weeks (P < 0.014 for all). Despite the similar preoperative baseline values, postoperative improvement, and clinical outcomes, our results suggest that the self-identified male patients will have poorer short-term satisfaction for disability, leg pain, back pain, and lifting versus patients in the self-identified female group. Self-identified gender might influence patient satisfaction and could be attributed to differing preoperative expectations at baseline for short-term recovery. [ABSTRACT FROM AUTHOR]

Limited literature has addressed impact of preoperative back pain severity on patient-reported outcome measures (PROMs), recovery ratios (RRs), and patient satisfaction following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). MIS TLIFs were retrospectively identified and grouped: preoperative visual analog scale (VAS) back ≤7 or VAS back >7. PROMs, including PROMIS-PF, VAS back and leg, Oswestry Disability Index (ODI), and SF-12 Physical Composite Score and Mental Composite Score (MCS), were collected pre- and postoperatively. A PROM's RR was calculated as proportion of postoperative improvement to overall potential improvement. In total, 740 patients were included: 359 patients with VAS back ≤7 and 381 patients with VAS back >7. The VAS back >7 cohort reported significantly greater postoperative inpatient pain (P ≤.003, both). All preoperative and the following postoperative PROMs favored the VAS back ≤7 cohort: PROMIS-PF 2-years, VAS back overall, SF-12 Physical Composite Score 12 weeks and 1 year, SF-12 MCS 6 weeks/12 weeks, VAS leg 6 weeks, 12 weeks, 6 months, and 2 years, and ODI overall (P ≤ 0.048, all). The VAS back >7 cohort demonstrated greater delta PROMs for all VAS back and ODI except 2 years (P ≤ 0.021, all). A greater proportion of patients in the VAS back >7 group achieved minimal clinically important difference for VAS back overall, ODI 6 weeks/12 weeks, PROMIS-PF 6 weeks, and SF-12 MCS 6 weeks/6 months (P ≤ 0.044, all). The VAS back>7 cohort RR was significantly greater for VAS back 6 months and VAS leg 6 months/2 years (P ≤ 0.034, all). The VAS back ≤7 cohort's postoperative satisfaction was significantly greater for VAS back 12 weeks, VAS leg 12 weeks, and ODI 6 weeks/12 weeks (P ≤ 0.046, all). Patients with greater preoperative back pain demonstrated significantly worse postoperative scores for most PROMs at most time points and significantly worse patient satisfaction for disability, back and leg pain at multiple time points. [ABSTRACT FROM AUTHOR]