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The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr's paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissuesparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF. [ABSTRACT FROM AUTHOR]

To compare patient-reported outcome measures (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement after minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients stratified by preoperative leg pain. Patients undergoing MIS-TLIF were collected through retrospective review of a prospectively maintained single-surgeon database. PROMs administered preoperatively/postoperatively included Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back/leg pain, Oswestry Disability Index (ODI), and 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS). Patients were grouped based on preoperative VAS leg scores: VAS leg ≤7 or VAS leg >7. Inferential statistics were used to compare PROMs, MCID achievement rates, and postoperative satisfaction between groups. A total of 562 patients were eligible (168 VAS leg score ≤7; 394 VAS leg score >7). Significant differences between cohorts in postoperative mean PROMs were noted for PROMIS-PF at 6 weeks/2 years, SF-12 PCS at 6 weeks/2 years, SF-12 MCS at 6 weeks/12 weeks/6 months/1 year, VAS back score at 6 weeks/12 weeks/6 months, VAS leg score at 6 weeks/12 weeks/6 months/2 years and ODI at all postoperative time points (P < 0.045, all). In the VAS leg score >7 cohort, a greater proportion achieving MCID for VAS leg score at all postoperative time points and ODI at 12 weeks (P < 0.010, all). Postoperative satisfaction was greater in VAS back score ≤7 cohort for VAS leg score at 6 weeks/12 weeks/6 months/2 years, VAS back score at 12 weeks/2 years, and ODI at 6 weeks/12 weeks/6 months/2 years (P < 0.046, all). Patients with severe preoperative leg pain showed worse postoperative PROM scores and patient satisfaction for disability and back/leg pain. MCID achievement rates across cohorts were similar. Patients with severe leg pain may have expectations for surgical benefits incongruent with their postoperative outcomes, and physicians may seek to manage the preoperative expectations of their patients to reflect likely outcomes after MIS-TLIF. [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]

To conduct a preliminary analysis on the impact of time to surgery (TTS) and duration of symptoms (DOS) on clinical outcomes in workers' compensation patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Patients using workers' compensation insurance undergoing primary, single-level MIS TLIF were identified. Patient-reported outcome measures (PROMs) were administered at preoperative/6-week/12-week/6-month postoperative time points and included visual analog scale (VAS) back/VAS leg/Oswestry Disability Index/12-Item Short-Form Physical Composite Score/12-Item Short-Form Mental Composite Score. Patients were grouped by TTS: <90 days, 90–179 days, and ≥180 days. Demographics were compared by χ2; perioperative characteristics, mean PROMs, and postoperative improvement (ΔPROM) were compared using 1-way analysis of variance. Minimum clinically important difference (MCID) achievement rates were compared using simple logistic regression. A secondary analysis was performed by grouping patients by DOS: <180 days, 180–364 days, and ≥365 days. Mean PROMs, ΔPROMs, and MCID achievement were similarly compared between DOS groups using 1-way analysis of variance and logistic regression. A total of 193 patients were included. Prevalence of herniated nucleus pulposus and initial appointment type were significantly associated with TTS (P < 0.042, all). No significant differences in mean PROMs or ΔPROMs were observed among TTS groups. MCID achievement was significantly lower for VAS back at 6 months in the longest TTS group. Mean PROMs were significantly different based on DOS for VAS leg at 6 weeks only. MCID achievement was significantly lower for the longest DOS group for VAS leg at 6 months only. ΔPROMs did not significantly differ among DOS groups. Neither TTS nor DOS was significantly associated with MIS TLIF outcomes. Workers' compensation patients may achieve similar clinical improvement even with longer symptom burden and substantial delays in operative treatment. [ABSTRACT FROM AUTHOR]

To compare patient-reported outcomes (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion stratified by preoperative disability. Minimally invasive transforaminal lumbar interbody fusions were grouped by preoperative Oswestry Disability Index (ODI) score: ODI <41 or ODI ≥41. PROMs administered pre/postoperatively included Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF), visual analog scale (VAS) back/leg, ODI, and 12-Item Short-Form Physical Composite Score (SF-12 PCS)/12-Item Short-Form Mental Composite Score (SF-12 MCS). Satisfaction scores were collected for VAS back/leg and ODI. Coarsened exact match controlled for differences between cohorts. T tests compared mean PROMs and postoperative improvement/satisfaction between cohorts. Simple logistic regression compared MCID achievement. After coarsened exact matching, there were 118 patients in the ODI ≤41 and 377 patients in the ODI >41 cohort. The ODI >41 cohort saw greater postoperative inpatient VAS pain score and narcotic consumption on days 0/1 (P < 0.018, all). PROMs differed between cohorts: PROMIS-PF, SF-12 PCS, ODI, VAS back/leg at all postoperative time points and SF-12 MCS at 6 weeks/12 weeks/6 months/1 year (P < 0.045, all). Patients in the ODI >41 cohort demonstrated greater proportion achieving MCID for ODI at all postoperative time points and for SF-12 MCS 6-week/12-week/6-month/1-year (P < 0.040, all). The ODI ≤41 cohort demonstrated greater MCID achievement for overall PROMIS-PF and SF-12 PCS 6 months (P < 0.047, all). Postoperative satisfaction was greater in the ODI ≤41 cohort for VAS leg 6 weeks/12 weeks, VAS back 6 weeks/12 weeks, and ODI all postoperative time points (P < 0.048, all). Preoperative disability associated with worse postoperative PROMs and patient satisfaction for disability, back/leg pain at multiple time points. MCID achievement rates across cohorts were similar for most PROMs at most postoperative time points. Patients with severe disability may have unrealistic expectations for surgical benefits, influencing corresponding postoperative satisfaction. [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]