Search

Study Design: Retrospective study. Purpose: To compare perioperative outcomes, patient-reported outcome measures (PROMs), and minimal clinically important difference (MCID) achievement rates for an obese patient cohort between single-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) vs. anterior lumbar interbody fusion (ALIF). Overview of Literature: To the best of our knowledge, no study has compared the outcomes of MIS TLIF and ALIF in an obese population. Methods: Obese patients (body mass index [BMI] =30.0 kg/m2) who underwent single-level MIS TLIF or ALIF at L5/S1 were included in the study. Demographic/perioperative variables, presenting patient pathology, and 1-year arthrodesis statistics were collected. PROM scores for Visual Analog Scale (VAS) back/leg, Oswestry Disability Index, 12-item Short Form Physical Composite Scale, and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) were collected from preoperative and postoperative (6 weeks, 12 weeks, 6 months, 1 year, 2 years) PROMIS-PF. The obese patients were classified based on the procedure they underwent (MIS TLIF vs. ALIF). Results: The criteria were met by 210 patients in total. After coarsened exact matching for Charlson comorbidity index score, degenerative spondylolisthesis, isthmic spondylolisthesis, degenerative scoliosis, foraminal stenosis, insurance, male, and ethnicity, 94 obese patients were included in the total cohort, with 59 receiving MIS TLIF and 35 receiving ALIF. ALIF recipients had higher PROMIS-PF scores at 6 weeks (p =0.014) and 12 weeks (p =0.030), as well as a higher VAS leg at 2 years (p =0.017). Following multiple regression accounting for differences in baseline BMI, only the 6-week PROMIS-PF significantly differed (p =0.028), with no other intergroup differences in mean PROMs between fusion types. Aside from a significantly higher 6-week MCID achievement rate for PROMIS-PF among ALIF recipients (p =0.006), no differences in attainment were observed. Conclusions: There were no statistically significant differences in perioperative characteristics, fusion rates, PROMs, or MCID achievement between obese patients receiving MIS TLIF vs. ALIF. As a result, our findings indicate that MIS TLIF and ALIF at L5/S1 are equally effective in an obese patient population. [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 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]

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]

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]