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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 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]

To determine preoperative 12-Item Short Form Health Survey (SF-12) Mental Component Summary (MCS) influence on minimally important clinical difference (MCID) and patient-reported outcome measures in patients with isthmic spondylolisthesis receiving minimally invasive transforaminal lumbar interbody fusion. Patients with isthmic spondylolisthesis undergoing primary, single-level minimally invasive transforaminal lumbar interbody fusion at L5-S1 were retrospectively identified and divided into preoperative SF-12 MCS <50 and SF-12 MCS ≥50 groups. Visual analog scale (VAS) back/leg, Oswestry Disability Index (ODI), SF-12 Physical Composite Score (PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were assessed. Improvements from preoperative score were analyzed via paired samples t test. Patient-reported outcome measures and MCID attainment between groups were evaluated using linear regression and χ2, respectively. SF-12 MCS <50 and SF-12 MCS ≥50 groups included 35 and 26 patients, respectively. SF-12 MCS < 50 group had inferior scores for all VAS back time points except 6 weeks, all VAS leg time points except 6 weeks/1 year, all ODI time points, SF-12 PCS at 6 months/2 years, and PROMIS-PF at preoperative/6 months (all P ≤ 0.049). SF-12 MCS <50 group improved for VAS back/leg to 1 year, ODI and SF-12 PCS from 12 weeks to 1 year, and PROMIS-PF at 1 year only (all P ≤ 0.047). SF-12 MCS ≥50 group improved for VAS back from 12 weeks to 1 year, SF-12 PCS 6 months to 2 years, and VAS leg, ODI, and PROMIS-PF 12 weeks to 2 years (all P ≤ 0.018). MCID attainment differed for ODI at 6 weeks and PROMIS-PF at 12 weeks only (both P ≤ 0.035). Patients with SF-12 MCS <50 demonstrated fewer long-term improvements from preoperative to 2 years and inferior patient-reported outcome measures at most time points for pain and disability following minimally invasive transforaminal lumbar interbody fusion. MCID attainment largely did not differ by preoperative mental functioning. [ABSTRACT FROM AUTHOR]

Lumbar fusion procedures are at risk for pseudarthrosis as a complication. Despite its relative prevalence, few studies have characterized the clinical efficacy of salvage procedures. To characterize clinical outcomes following anterior lumbar interbody fusion (ALIF) as a salvage procedure for pseudarthrosis of transforaminal lumbar interbody fusion (TLIF). Retrospective. Thirty-four ALIF patients. VAS back and leg, ODI, SF-12 PCS, VR-12 PCS. A retrospective review of a surgical database of eligible procedures between November 2010 and June 2020 was performed. Inclusion criteria were as follows: single-level revision ALIF procedures performed at the index level for pseudarthrosis of TLIF. Patients were excluded if procedures were primary or performed for infectious, malignant or traumatic etiologies. Demographic and perioperative characteristics were collected. Additionally, time to revision, rates of 1-year arthrodesis, 6-month pseudarthrosis and postoperative complications were calculated. Radiographic measurements were performed to evaluate sagittal alignment and disc height at the preoperative, immediate postoperative and final postoperative timepoint. Differences between preoperative and final postoperative radiographic measurements were evaluated using a Student's t-test. Visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-Item Short Form physical composite score (SF-12 PCS and VR-12 PCS) were collected preoperatively and postoperatively. Overall achievement of a minimum clinically important difference (MCID) was calculated using the following established values: 1.2 (VAS Back), 1.6 (VAS leg), 12.8 (ODI), 4.0 (SF-12 PCS). A total of 34 patients who underwent an ALIF revision procedure at the index level were identified. Mean age was 46.7 years with 81.1% being male and 64.9% obese (body mass index: 30 kg/m2). A total of 83.8% had an ASA < 2 and 75.5% carried a CCI > 1. Mean time from index TLIF to salvage ALIF procedure was 21.3 months. Mean operative time was 135.3 minutes with an average blood loss of 75.0mL and hospital length of stay of 49.5 hours. The majority of procedures were performed at the L5-S1 level (73.5%). Patients demonstrated a one-year arthrodesis rate of 100.0% with 2/34 patients requiring an additional revision procedure at the index level for neuroforaminal bone growth. A total of six postoperative complications were observed with one patient suffering from a mild urinary tract infection, one with acute renal failure, one with a venous thromboembolism, one with altered mental status, and two with fever of unknown origin. Following ALIF salvage, there was a significant increase in segmental lordosis, mean anterior and posterior disc height, as well as average disc height (p≤0.037, all). Mean preoperative outcome scores were 7.2 ± 1.9 for VAS back, 6.8 ± 2.8 for VAS leg, 56.7 ± 16.5 for ODI, and 28.1 ± 10.9 for SF-12 PCS. Clinically relevant improvement of PROMs as measured by MCID achievement rates by one-year were 67.1% for VAS back, 57.1% for VAS leg, 40.0% for ODI and 37.5% for SF-12 PCS. Use of ALIF as a salvage procedure at either the L4-5 or L5-S1 level for TLIF pseudoarthrosis demonstrated a high arthrodesis rate at one-year. Patients demonstrated high rates of MCID achievement for back and leg pain, as well as ODI. These results support the use of ALIF as a salvage procedure for failed TLIFs at the L4-5 and L5-S1 levels. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]