Search

Study Design: Retrospective cohort.Purpose: To investigate the impact of meeting a patient’s preoperative expectations for back or leg pain or the achievement of minimum clinically important difference (MCID) on patient satisfaction following lumbar fusion.Overview of Literature: Few studies have compared if MCID achievement or meeting preoperative expectations for pain reduction affects patient satisfaction.Methods: A surgical database was reviewed for eligible patients who underwent lumbar fusion. Patient satisfaction and Visual Analog Scale (VAS) for back and leg pain were the outcomes of interest. Meeting expectations was calculated as a difference of ≤0 between preoperative expectations and postoperative VAS scores. MCID achievement was calculated by comparing changes in VAS scores with established values. Meeting preoperative expectations or MCID achievement as predictors of patient satisfaction was evaluated using regression analysis.Results: A total of 134 patients were included in this study. Patients demonstrated significant improvements in VAS back and VAS leg (pp≤0.024). Meeting VAS leg expectations and MCID achievement both demonstrated a significant association with patient satisfaction at all postoperative timepoints (all, p≤0.02). No differences between MCID achievement and meeting expectations as predictors of satisfaction were noted.Conclusions: The majority of patients achieved MCID and had their back and leg pain expectations met by 1 year. Both measures were significant predictors of patient satisfaction and suggest that MCID achievement may act as a suitable substitute for patient satisfaction.

BACKGROUND: Veterans RAND 12-item (VR-12) physical component score (PCS) has been validated in both veteran and US citizen populations; however, its use for spine surgery populations has not been evaluated. This study aims to correlate the VR-12 PCS survey with legacy patient-reported outcome measures (PROMs) in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS: A prospective surgical database was retrospectively assessed for MIS TLIFs performed at 1 level from March 2015 to June 2019. Inclusion criteria were elective procedures for degenerative spinal pathology. Patients were excluded if they had surgery for metastatic, traumatic, or infectious etiologies or had incomplete preoperative 12-item Short Form (SF-12) PCS or Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) survey. Additionally, patients with any incomplete VR-12 PCS surveys through 1 year were excluded. Demographics and perioperative characteristics were recorded. Mean postoperative PROM scores and score difference from preoperative baseline were calculated at each postoperative timepoint through 1 year. The relationship of VR-12-PCS with SF-12-PCS and PROMIS PF was evaluated with a Pearson’s correlation coefficient and time-independent partial correlation. RESULTS: A total of 59 patients underwent single-level MIS TLIFs. The cohort was 44.1% women with an average age of 53.8 years, and 52.5% were obese (body mass index ≥30 kg/m(2)). The VR-12 PCS, SF-12 PCS, and PROMIS PF surveys had significant improvements from baseline to the 6 month through 1 year postoperative timepoints (P ≤ 0.001, all). All timepoints revealed strong VR-12-PCS correlations with SF-12-PCS and PROMIS PF (all P ≤ 0.001). CONCLUSION: VR-12 PCS, SF-12 PCS, and PROMIS PF scores all indicate statistically significant improvements in physical function for patients following MIS TLIF. VR-12 PCS was strongly correlated with the historically validated SF-12 PCS system as well as with the more recent PROMIS PF survey. Our observations give weight to utilizing the VR-12 PCS survey as a valid measure of physical function among patients undergoing MIS TLIF. CLINICAL RELEVANCE: This study validates VR-12 PCS to measure physical function for TLIF patients. LEVEL OF EVIDENCE: 4.

This was a retrospective cohort study.The objective of this study was to evaluate the impact of undergoing a prior lumbar procedure on mental health outcomes following anterior cervical discectomy and fusion.Revision and reoperations are perceived as risk factors for worse mental health outcomes.A retrospective review of a surgical database was performed for cervical and lumbar procedures. The mental health measures used were: Short Form 12-Item Mental Composite Score (SF-12 MCS) and Patient Health Questionnaire 9 (PHQ-9). Secondary outcomes of interest were Visual Analogue Scale for neck and arm pain, Neck Disability Index, and Short Form 12-Item Physical Composite Score (SF-12 PCS). All outcomes were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Minimum clinically important difference (MCID) was calculated using established values. Patients were grouped based on the surgical history of an elective lumbar spine procedure and propensity-matched. Differences in postoperative outcome scores and MCID achievement were evaluated using linear and logistic regression respectively.A total of 74 patients were included in this study. Mental health outcomes did not demonstrate significant differences between groups for SF-12 MCS and PHQ-9 for all time points except at 6 weeks for PHQ-9 ( P =0.038). MCID achievement was not significantly impacted by surgical history for all outcome measures at all postoperative time points (all P0.050). The majority of patients achieved an MCID by the 1-year time point for all outcomes for patients without a prior lumbar surgery except for Visual Analogue Scale arm and SF-12 PCS, while those with a surgical history achieved an MCID for all outcomes except SF-12 PCS and PHQ-9.Anterior cervical discectomy and fusion patients with a past history of lumbar surgery demonstrated significant improvements in depression, neck and arm pain, disability, and physical function as those without a past lumbar surgical history. Prior surgery also did not impact MCID achievement for all outcomes.

OBJECTIVE The Physical Component Score of the Veterans RAND 12 Item Health Survey (VR-12 PCS) has been assessed for use at short-term and intermediate-term time points for lumbar fusion populations. This study assesses the long-term validity and establishes minimal clinically important difference (MCID) values of VR-12 PCS in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). METHODS A surgical registry was retrospectively reviewed for primary, elective, single-level MIS TLIF procedures with posterior instrumentation. Patients missing preoperative and 2-year postoperative VR-12 PCS survey data were excluded. VR-12 PCS, SF-12 Health Survey Physical Component Summary (SF-12 PCS), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF), and Oswestry Disability Index (ODI) patient-reported outcome measures (PROMs) were recorded preoperatively and postoperatively. Responsiveness of the VR-12 measure was assessed in two ways. First, the mean postoperative PROM scores were compared with preoperative baseline values using a paired Student t-test. Second, MCID values were calculated using both distribution-based and anchor-based methods and used to assess improvement in VR-12 score at the 2-year time point. Discriminant validity of the VR-12 was assessed using cross-sectional and longitudinal anchors. Convergent validity of the VR-12 measure was assessed using Pearson’s correlation coefficient and partial time-independent correlation. Floor and ceiling effects were assessed. RESULTS A total of 74 patients who underwent MIS TLIF were included. The VR-12 PCS demonstrated significant improvements at all time points from 12 weeks to 2 years (p < 0.001 for all). VR-12 PCSs were significantly different for patients classified using cross-sectional anchors (p < 0.001) and longitudinal anchors (p ≤ 0.005). Calculated MCID values ranged from 4.1 to 8.5, and 4.1 was selected as the optimal MCID, which 87.8% of patients achieved. Strong, significant correlations of the VR-12 PCS with SF-12 PCS and PROMIS PF were demonstrated at all time points (p < 0.001 for all). No significant floor or ceiling effects were detected. CONCLUSIONS The VR-12 PCS demonstrated excellent responsiveness, discriminant and convergent validity, and no significant floor or ceiling effects up to 2 years after MIS TLIF. Therefore, VR-12 PCS may serve as a valid measure of long-term physical function.

Study Design: Retrospective cohort.Purpose: This study aimed to assess the relationship between preoperative narcotic consumption and patient-reported outcomes (PRO) in patients undergoing minimally invasive (MIS) lumbar decompression (LD).Overview of Literature: Previous studies report negative effects of narcotic consumption on perioperative outcomes and recovery; however, its impact on quality of life and surgical outcomes is not fully understood.Methods: A surgical database was retrospectively reviewed for patients undergoing primary, single-level MIS LD from 2013 to 2020. Patients lacking preoperative narcotic consumption data were excluded. Demographics, spinal pathologies, and operative characteristics were collected. Patients were grouped based on preoperative narcotic consumption. Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-item Short Form Physical Component Summary, and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) were collected preoperatively and postoperatively. Preestablished values were used to calculate achievement of minimum clinically important difference (MCID). Differences in mean PROs and MCID achievement between groups were evaluated.Results: The cohort was 453 patients; 184 used preoperative narcotics and 269 did not. Significant differences were found in American Society of Anesthesiologists classification, ethnicity, insurance type, and estimated blood loss between groups. Significant differences were also found in preoperative PHQ-9, VAS leg, ODI, and PROMIS-PF between groups (all pp>0.05). A higher rate of MCID achievement was associated with the narcotic group for PHQ-9 and PROMIS-PF at 6 weeks (both p≤0.050), VAS leg at 1 year (p=0.009), and overall for ODI and PHQ-9 (both p≤0.050).Conclusions: Preoperative narcotic consumption was associated with worse preoperative depression, leg pain, disability, and physical function. In patients consuming preoperative narcotics, a higher proportion achieved an overall MCID for disability and depressive symptoms. Patients taking preoperative narcotic medications may report significantly worse preoperative PROs but demonstrate greater improvements in postoperative disability and mental health.

Objective: This study aims to compare the impact of achieving an MCID or meeting preoperative expectations on patient satisfaction following cervical spine procedures.Methods: A surgical database was retrospectively reviewed for cervical spine surgery patients from 2016 to 2020. Inclusion criteria were primary or revision, single- or multilevel cervical disc arthroplasty or anterior cervical discectomy and fusions (ACDF). Visual analogue scale (VAS) neck and arm pain was assessed preoperatively and postoperatively (6-week, 12-weeks, 6-months, 1-year). Preoperative patient expectation and postoperative satisfaction were recorded. MCID achievement was determined using previously established values. Expectations met and MCID achievement were compared as possible predictors of satisfaction.Results: One hundred and six cervical spine patients were included. Both meeting expectations and achieving MCID were significant predictors of satisfaction for arm pain at 6-weeks and 12-weeks (all p≤0.007). Achieving MCID significantly predicted satisfaction for neck pain at all timepoints (all p≤0.007) and meeting expectations predicted satisfaction for neck pain at 6-weeks, 12-weeks, and 1-year (all p≤0.003). Comparison of coefficients revealed no significant difference in effect size between meeting expectations and achievement of MCID as predictors of patient satisfaction (all p>0.050).Conclusion: MCID achievement and meeting expectations were significant predictors of satisfaction for neck pain and short-term arm pain. Both measures may be similarly useful for interpretation of patient outcomes and the optimal choice of metric may depend on practice-specific factors.

Retrospective cohort.The aim was to determine how neck pain and disability improve following anterior cervical discectomy and fusion among patients with myeloradiculopathy.Neck pain and disability have traditionally been assessed using the neck disability index (NDI) and visual analog scale (VAS). Few studies have investigated how neck pain/disability improve differently among patients with symptoms of both myelopathy and radiculopathy.Patients were identified through retrospective review of a prospective surgical database from 2013 to 2020. Patient-reported outcome measures (PROMs) collected included VAS neck and arm, NDI, 12-Item Short Form physical composite score (SF-12 PCS), Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF), and Patient Health Questionnaire 9 (PHQ-9). PROMs were collected preoperatively and up to 1-year postoperatively. Patients were categorized by preoperative symptom severity: high VAS arm (7); high NDI (55); high VAS arm and NDI; and moderate symptoms. Linear and logistic regression evaluated the impact of preoperative symptom severity on PROM scores and achievement of minimum clinically important difference (MCID), respectively.A total of 187 patients were included, 98 with neither high VAS arm nor NDI (moderate group), 14 with high NDI, 46 with high VAS arm, and 29 with high NDI and VAS arm. Postoperatively, greater symptom severity was a significant predictor of VAS neck (all timepoints; P ≤0.002, all), VAS arm (6 weeks; P =0.007), NDI (6 weeks to 6 months; P0.001, all), SF-12 PCS (6 months; P =0.004), P ROMIS PF (6 weeks; P =0.007), and PHQ-9 (6 weeks to 6 months; P0.001, all). Mean postoperative improvement was different among the four severity groups for VAS arm, NDI, and VAS neck (except for 1-year) ( P ≤0.002, all). Overall MCID achievement rates were significantly greater among higher symptom severity groups across VAS arm and NDI ( P ≤0.003, both).PROM improvement and MCID achievement for NDI, VAS neck, and VAS arm differed based on symptom severity.

The Neck Disability Index (NDI) is a well-established measure for patients with cervical myelopathy, radiculopathy, or myeloradiculopathy. Few studies have examined the relationship between NDI and mental health outcomes after anterior cervical diskectomy and fusion (ACDF). Our study sets out to determine the possible correlations between NDI and mental health outcome measures after ACDF.A prospectively maintained surgical registry was retrospectively reviewed for elective ACDF procedures from December 2013 to December 2019. Demographic and perioperative characteristics were collected. Primary outcomes of interest were NDI, 12-Item Short Form Mental Component Summary (SF-12 MCS), and Patient Health Questionnaire-9 (PHQ-9). Outcomes were collected preoperatively and postoperatively (6 weeks, 12 weeks, 6 months, 1 year, and 2 years). Postoperative improvement for all outcomes was evaluated using a paired Student t-test. Correlations between NDI and mental health outcomes were evaluated using the Pearson correlation coefficient. Strength of association was determined using the following criteria: weak (0.1 ≤ |r|0.3), moderate (0.3 ≤ |r|0.5), and strong (|r| ≥ 0.5).A total of 225 patients were included in this study. Most of the patients underwent a single-level procedure and had a spinal pathology of herniated nucleus pulposus. NDI demonstrated significant improvements through 2 years compared with preoperative values (all P0.001). Similarly, SF-12 MCS and PHQ-9 significantly improved through 1-year postoperatively (all P ≤ 0.010) but was not maintained at 2 years (P = 0.835; P = 0.128). NDI demonstrated a significant but moderate correlation with SF-12 MCS at the preoperative time point, but a strong correlation was observed at all postoperative time points (all P ≤ 0.001). A significant and strong correlation between NDI and PHQ-9 was demonstrated at all time points (all P ≤ 0.002).NDI demonstrated notable and strong correlations with mental health outcome measures at all postoperative time points. NDI is an effective measure to assess neck disability but may also help capture changes to mental health symptoms after ACDF.

BACKGROUND: Patients receiving workers’ compensation demonstrate a propensity for poorer postoperative outcomes. This study aims to determine rates of minimum clinically important difference (MCID) achievement in patients receiving workers’ compensation following transforaminal lumbar interbody fusion (TLIF). METHODS: We retrospectively reviewed a prospective surgical database from 2015 to 2020 for primary, single-level TLIFs with posterior instrumentation for degenerative spinal pathologies. Visual analog scale (VAS) for back and leg, Oswestry Disability Index (ODI), 12-Item Short Form Physical Component Summary (SF-12 PCS), and Patient-Reported Outcome Measurement Information System physical function (PROMIS-PF) were collected pre- and postoperatively. Patients were separated by workers’ compensation (WC) status. Propensity score matching was performed to account for differences in demographic characteristics. Postoperative improvements in patient-reported outcome measures (PROMs) were calculated using paired Student’s t test, and intergroup differences were determined by Mann-Whitney U test. Achievement of MCID was determined using established values, and intergroup differences were assessed using χ (2) analysis. RESULTS: A total of 121 patients were included in this study with 29 WC and 92 non-WC patients. The mean age was 53.5 years with the majority being men (63.6%) and nonobese (54.5%). WC patients demonstrated significantly poorer PROM values at all timepoints except for preoperative VAS back (P = 0.297) and leg (P = 0.475). Overall achievement of MCID was significantly lower for WC patients for VAS back (P = 0.040), ODI (P = 0.001), SF-12 PCS (P = 0.010), and PROMIS-PF (P = 0.039). CONCLUSION: WC patients demonstrated poorer postoperative outcomes at multiple timepoints. Additionally, a significantly lower rate of MCID achievement for back pain, disability, and physical function was observed for WC patients. CLINICAL RELEVANCE: These results suggest that WC patients may require alternative preoperative counseling about realistic expectations for improvement following lumbar fusion. LEVEL OF EVIDENCE: 3.

BACKGROUND: Few studies have investigated the effects of preoperative depression and multilevel procedures on patient-reported outcomes (PROs) following anterior cervical discectomy and fusion (ACDF). This study aims to determine the impact of preoperative depression on PROs in single vs multilevel ACDF procedures. METHODS: Eligible primary single or multilevel ACDF procedures were retrospectively reviewed from 2015 to 2020 using a surgical database. PROs included visual analog scale (VAS), Neck Disability Index (NDI), 12-Item Short Form Physical Composite Summary and Mental Composite Summary (SF-12 PCS and MCS), and Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF). PROs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. Patients were stratified into 3 groups based on Patient Health Questionnaire-9 (PHQ-9) score. Differences in PROs were assessed based on preoperative depression severity or both preoperative depression severity and number of operative levels. RESULTS: Our patient cohort included 42 individuals with minimal preoperative depressive symptoms, 32 having mild and 27 having moderate to severe. Baseline PRO values were significantly different between groups (all P < 0.01). Improvement significantly differed between groups at 6 weeks for VAS arm, NDI, and SF-12 MCS (all P < 0.05), and at 12 wweeks for VAS neck, NDI, SF-12 PCS and MCS, and PROMIS PF (all P < 0.05). SF-12 PCS and MCS at 6 months and VAS arm and SF-12 MCS at 1 year demonstrated significant intergroup differences (all P < 0.05). VAS arm at 1 year (P = 0.029), NDI at 12 weeks (P = 0.034), PROMIS PF at 6 weeks (P = 0.038), and SF-MCS at all postoperative time points were impacted by both preoperative depression severity and number of levels fused. CONCLUSION: Depression severity impacted recovery of pain, disability, and physical function preoperatively and at intermittent postoperative time points. Both severity and multilevel procedures impacted pain and mental health at intermittent postoperative time points. In addition to depression, multilevel ACDF procedures are an additional factor that must be considered in expected improvement of postoperative outcomes. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: Multilevel ACDF procedures and preoperative depression severity both impact postoperative pain, disability, and physical function.

BACKGROUND: Limited research exists regarding the influence of preoperative depression on postoperative mental health, physical function, and pain in lumbar decompression (LD) patients. This study aims to evaluate the association of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9) with other mental health and physical function clinical outcomes among patients undergoing LD. METHODS: A prospectively maintained surgical registry was reviewed for primary LD from March 2016 to May 2019. Patients were stratified into 3 preoperative PHQ-9 score subgroups. Higher PHQ-9 scores indicated greater depressive symptoms. We assessed demographic and perioperative characteristics among subgroups with appropriate statistical testing. We also evaluated outcome instruments and postoperative improvement for the following outcomes: PHQ-9, Short Form 12 (SF-12), Veterans RAND 12-Item (VR-12), Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) leg, and VAS back. RESULTS: The 351-subject cohort was 70.4% men with an average age of 47 years; 186 subjects had minimal preoperative depressive symptoms (PHQ-9 10). Subgroups with more severe symptoms of depression had worse mental health outcome scores (PHQ-9, 12-Mental Health Composite Score [12-MCS], and VR-12-MCS) and a positive linear association with greater pre- to postoperative mental health improvements at all timepoints. Subgroups with more severe symptoms of depression had worse PROMIS-PF scores at all timepoints, though VAS pain scores had no depression symptom association by 1 year. CONCLUSION: Patients with more severe preoperative depressive symptoms, as evaluated by PHQ-9, have a greater improvement in PHQ-9, SF-12, and VR-12 scores, but more severe PHQ-9 scores are associated with worse overall physical function scores. This study demonstrates the relevance of preoperative depressive symptoms and their necessity in future risk factor models. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Severity of preoperative PHQ-9 acts as a significant risk factor to postoperative pain and mental and physical health improvement.

Research has suggested that workers' compensation (WC) status can result in poor outcomes after anterior cervical diskectomy and fusion (ACDF).To determine the influence WC status has on postoperative clinical outcomes after ACDF.A surgical database was reviewed for patients undergoing primary or revision single-level ACDF. Patients were grouped into WC vs Non-WC, and differences in baseline characteristics were assessed. Postoperative improvement was assessed for differences in mean scores between WC subgroups for visual analog scale (VAS) arm, VAS neck, 12-item Short Form Physical Composite Score, Patient-Reported Outcomes Measurement Information System physical function (PF), and Neck Disability Index (NDI) at preoperative and postoperative time points. Minimum clinically important difference (MCID) achievement was compared between groups.The patient cohort included 44 with WC and 95 without. The cohort was 40% female with an average age of 48 years and mean body mass index of 30. Mean VAS arm, VAS neck, NDI, 12-item Short-Form Physical Composite Score, and Patient-Reported Outcomes Measurement Information System PF scores differed between groups; however, the difference was not sustained at the 1-yr time point. MCID achievement among WC subgroups was different for VAS arm (6 wk through 6 mo, P = .005), VAS neck (3 and 6 mo, P.01), and NDI (3 and 6 mo, P.05). No statistically significant difference was noted between cohorts for overall rates of MCID achievement for all patient-reported outcome measures collected.WC patients reported similar preoperative and 1-yr postoperative neck and arm pain compared with non-WC patients after ACDF. One-yr MCID achievement rates were similar between cohorts for disability and PF scores.

BACKGROUND: Few investigations have focused on the predictive value of Patient-Reported Outcomes Measurement Information System (PROMIS) scores, patient depression measured by the Patient Health Questionnaire-9 (PHQ-9), and their relationship in the setting of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). This study aims to detail the association between preoperative physical function with postoperative change in physical function and in depressive symptoms. METHODS: A prospectively maintained surgical registry was retrospectively reviewed from March 2016 to February 2019. Inclusion criteria were primary, single-level MIS TLIF procedures. Multilevel procedures and patients without PROMIS or PHQ-9 were excluded. Patients were grouped by preoperative PROMIS score (

Background 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. Methods 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. Results 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. Discussion 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.

BACKGROUND: As spine surgery in the ambulatory setting becomes more frequent, patients should comprehend the difference from traditional hospital-based, outpatient settings. Limited research exists on the readability of online articles surrounding spine surgery in the ambulatory surgery center (ASC). In this study, we intend to evaluate the readability of online articles pertaining to spine surgery in the outpatient and ambulatory surgical settings. METHODS: Three search engines were queried, and the first 100 articles pertaining to each outpatient spine surgery search term were collected. Advertisements, videos, and peer-reviewed scientific articles were excluded. Articles were categorized by publishing source as follows: hospital or institution, general medical Websites, private practice, or surgery center. Flesch-Kincaid (FK) grade level, Flesch Reading Ease (FRE) score, word count, sentences per paragraph, words per sentence, and characters per word were evaluated for each article. Student's t tests compared readability metrics between groups based on setting and procedure region. RESULTS: A total of 342 articles was analyzed; 279 articles were outpatient hospital related, and 63 ASC related. Flesch-Kincaid grade levels or FRE scores were not significantly different between outpatient hospital and ambulatory center. Comparison of ASC to outpatient articles from a hospital or institution source significantly differed in FRE score (40.7 versus 32.4) and FK grade level (12.3 versus 13.9; all P < .05). Articles addressing procedure type were significantly different in FRE score (36.2 versus 30.0) and FK grade level (13.0 ± 2.1 versus 14.3 ± 1.8). CONCLUSIONS: Hospital, private practice, and medical journalists should be aware of significant differences in readability of patient-accessible ASC articles. These articles may be more difficult to read than outpatient hospital articles, and production of more reading-level-appropriate online literature is required. LEVEL OF EVIDENCE: 3 CLINICAL RELEVANCE: There is a significant difference in the readability of patient-accessible ASC articles.

Meeting patient expectations is believed to impact satisfaction scores; however, the influence of achieving a minimum clinically important difference (MCID) is scarcely reported. This study aims to evaluate meeting patient expectations or MCID achievement for pain and disability as predictors of patient satisfaction.A retrospective review of single or multilevel lumbar fusion patients was performed. Patients with missing preoperative Oswestry Disability Index (ODI) expectation questionnaires were excluded. Preoperative expectations and postoperative satisfaction scores for visual analog scale (VAS) back, VAS leg, and ODI were collected. Meeting expectations was defined as scores less than or equal to preoperative expectations. Achievement of MCID was evaluated. Improvement of all outcomes and correlations with satisfaction scores were evaluated using the Student's t-test and Pearson coefficient. Achievement of MCID or meeting expectations as predictors of satisfaction were evaluated and compared using linear regression and Suest test.The study included 144 patients. All outcomes significantly improved and demonstrated significant correlations with satisfaction scores (P0.001, all). Patients reported a mean expectation of 17.7 (ODI), 1.7 (VAS back), and 0.9 (VAS leg). The majority had their expectations met and achieved MCID. Meeting expectations and MCID achievement demonstrated significant associations with satisfaction scores for all outcomes and time points. Achievement of MCID was a stronger predictor of satisfaction for ODI and VAS back.Meeting preoperative expectations and achievement of an MCID for pain and disability measures was significantly associated with satisfaction. Achievement of MCID may be a more consistent and suitable replacement as a predictor of satisfaction over meeting patient expectations.

BACKGROUND: There is a scarcity of research on the Charlson Comorbidity Index (CCI) and its influence on minimum clinically important difference (MCID) achievement after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). The objective of this study is to detail the association between the CCI and attaining MCID after MIS TLIF. METHODS: A prospective surgical registry was retrospectively reviewed for spine surgeries between May 2015 and February 2019. Inclusion criteria were primary or revision, 1- or 2-level MIS TLIF procedures. Patients were stratified based on CCI score: 0 points (no comorbidities), 1–2 points (mild CCI), ≥3 points (moderate CCI). Preoperative, intraoperative, and postoperative variables were assessed by subgroup using appropriate statistical analysis. Subgroups were analyzed with linear regression or χ(2) tests for continuous or categorical variables, respectively. Subgroup scores, improvement, and MCID achievement were assessed at postoperative timepoints (eg, 6 weeks, 12 weeks, 6 months, and 1 year) for back and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Composite Score (PCS), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF). RESULTS: A total of 171 patients were included (n = 51 [no comorbidities], n = 73 [mild CCI], and n = 47 [moderate CCI]). Higher CCI patients were older and more likely to be smokers, diabetic, arthritic, hypertensive, or have a malignancy history (P < 0.003). Preoperatively, ODI and PROMIS PF were the only patient-reported outcomes with a significant association by CCI group (P = 0.015 and 0.014). Back pain was the only measure that had a significant association with the CCI subgroup at 1 year for score (P = 0.002) or MCID (P = 0.028). CONCLUSIONS: By 1 year, regardless of the number of comorbidities, a similar proportion of patients undergoing MIS TLIF were able to achieve MCID for visual analog scale leg, SF-12 PCS, and PROMIS PF. Patients with higher comorbidities are not likely to experience a significant difference in symptom improvement. Regardless of CCI score, MIS TLIF can have a significant benefit for patients. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: Text.

Objective The Patient Health Questionnaire-9 (PHQ-9) is a screening tool for evaluating depressive symptoms. Research is scarce regarding the validity and correlation of PHQ-9 scores with other patient-reported outcomes of mental health after minimally invasive lumbar discectomy (MIS LD). We aim to validate PHQ-9 as a metric for assessing mental health in MIS LD patients. Methods A database was retrospectively reviewed for patients who underwent elective, single-level MIS LD. Patients were excluded if they had incomplete preoperative PHQ-9, 12-item Short Form Health Survey (SF-12), or Veterans RAND 12-item health survey (VR-12). Survey scores were collected preoperatively and postoperatively through 1 year. Mean scores were used to calculate postoperative improvement from preoperative scores. Correlation of PHQ-9 with SF-12 mental composite score (MCS) and VR-12 MCS scores was also calculated. Correlation strength was assessed by the following categories: 0.1 ≤ |r| < 0.3 = low; 0.3 ≤ |r| < 0.5 = moderate; |r| ≥ 0.5 = strong. Results A total of 239 patients underwent single-level MIS LD. PHQ-9, VR-12 MCS, and SF-12 MCS all demonstrated statistically significant increases from preoperative scores at all postoperative timepoints (p ≤ 0.001). SF-12 MCS and VR-12 MCS were each observed to have strong and significant correlations with PHQ-9 at all timepoints when evaluated with both Pearson correlation coefficients and partial correlation coefficients. Conclusion We observed that PHQ-9, SF-12 MCS and VR-12 MCS all significantly improve following lumbar discectomy and that PHQ-9 scores strongly correlated with these previously established measures. Our results substantiate evidence from other surgical fields that PHQ-9 scores are a valid tool to evaluate pre- and postsurgical depressive symptoms.

STUDY DESIGN This was a systematic review study. PURPOSE This study aims to review current literature to determine the rates of complications in relation to spine surgery in ambulatory surgery centers (ASC). BACKGROUND Recent improvements in anesthesia, surgical techniques, and technological advances have facilitated a rise in the use of ASC. Despite the benefits and lower costs associated with ASCs, there is inconsistent reporting of complication rates. METHODS This systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pertinent studies were identified through Embase and PubMed databases using the search string ((("ambulatory surgery center") AND "spine surgery") AND "complications"). Articles were excluded if they did not report outpatient surgery in an ASC, did not define complications, were in a language other than English, were non-human studies, or if the articles were classified as reviews, book chapters, single case reports, or small case series (≤10 patients). The primary outcome was the frequency of complications with respect to various categories. RESULTS Our query identified 150 articles. After filtering relevance by title, abstract, and full text, 22 articles were included. After accounting for 2 studies that were conducted on the same study sample, a total of 11,245 patients were analyzed in this study. The most recent study reported results from May 2019. While 5 studies did not list their surgical technique, studies reported techniques including open (6), minimally invasive surgery (2), endoscopic (4), microsurgery (1), and combined techniques (4). The following rates of complications were determined: cardiac 0.29% (3/1027), vascular 0.25% (18/7116), pulmonary 0.60% (11/1839), gastrointestinal 1.12% (2/179), musculoskeletal/spine/operative 0.59% (24/4053), urologic 0.80% (2/250), transient neurological 0.67% (31/4616), persistent neurological 0.61% (9/1479), pain related 0.57% (20/3479), and wound site 0.68% (28/4092). CONCLUSIONS After literature review, this is the first study to comprehensively analyze the current state of literature reporting on the complication profile of all ASC spine surgery procedures. The most common complications were gastrointestinal (1.12%) and the most infrequent were vascular (0.25%). Case reports varied significantly with regard to the type and rate of complications reported. This study provides complication profiles to assist surgeons in counseling patients on the most realistic expectations.

BACKGROUND: While depressive symptoms improve for most patients following minimally invasive lumbar decompression (MIS LD), for some, symptoms may worsen. This study aimed to investigate predictors of change in depressive symptoms in the short-term postoperative period following MIS LD. METHODS: We retrospectively analyzed a prospective surgical database for patients undergoing primary MIS LD procedures from 2016 to 2020. Preoperative pain (visual analog scale back and leg) scores were recorded, and the 9-Item Patient Health Questionnaire (PHQ-9) was administered at the preoperative and postoperative (6 weeks, 12 weeks, 6 months, and 1 year) timepoints. Patients were grouped into 1 of 3 categories of depression severity based on preoperative PHQ-9 scores: minimal (0–4), mild (5–9), and moderate to severe (10–27). Postoperative change in depressive symptoms was calculated by determining differences from baseline scores to scores at 6 weeks, 12 weeks, and 6 months. Analysis of demographics, perioperative characteristics, and spinal pathologies was conducted using χ (2) test. Significant factors contributing to postoperative changes in depression were analyzed using multiple linear regression analysis. Significance was set at P = 0.05. RESULTS: The 216 patients included had a mean age of 48 years, and a majority were men (70.4%). Most patients had a preoperative diagnosis of spinal stenosis (90.3%) or herniated nucleus pulposus (69.9%). Univariate analysis identified age, ethnicity, insurance, and diabetes as significant variables among depression severity groups. Patients demonstrated significant improvements in depressive symptoms at all postoperative timepoints (P < 0.001). Multivariate analysis identified several significant predictors of postoperative change in PHQ-9, which included moderate to severe preoperative depression for all postoperative timepoints (all P ≤ 0.038), mild preoperative depression for 6 weeks and 12 weeks (both P ≤ 0.029), and private insurance (P = 0.002) and smoking status (P = 0.047) at 12 weeks. CONCLUSION: Depression improved at all postoperative timepoints following LD. Insurance type, smoking status, and preoperative depression severity were all identified as significant predictors of postoperative changes in depressive symptoms. CLINICAL RELEVANCE: This study explores predictors of changes in depressive symptoms following LD. LEVEL OF EVIDENCE: 3.

BACKGROUND: Past studies outline potential risk factors for dysphagia following anterior cervical discectomy and fusion (ACDF). Few studies explored the impact of dysphagia, as measured by the swallowing quality of life (SWAL-QOL), on postoperative patient-reported outcome measure (PROM) improvement. This study aimed to determine the relationship between dysphagia and improvement in pain, disability, physical function, and mental health following ACDF. METHODS: A retrospective review of patients undergoing primary 1- or 2-level ACDF was performed. Individuals without a completed preoperative SWAL-QOL were excluded. Outcomes were collected for visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), 9-Item Patient Health Questionnaire (PHQ-9), and SWAL-QOL. Postoperative improvement from preoperative values was evaluated using a paired t test. The impact of SWAL-QOL on each PROM was assessed using linear regression. RESULTS: A total of 91 patients were included. Mean preoperative SWAL-QoL was 90.4, which worsened at 6 weeks and resolved by 6 months (P ≤ 0.007, both). VAS neck and arm scores significantly improved postoperatively (P < 0.001), as did the NDI score (P < 0.001). Physical function significantly improved at 12 weeks and 6 months (P ≤ 0.021, both). Depressive symptoms improved at 6 weeks and 12 weeks (P ≤ 0.007, both). Preoperatively, SWAL-QOL demonstrated significant relationships with all PROMs (P ≤ 0.005, all). At 6 weeks, 12 weeks, and 6 months (P ≤ 0.048, all), SWAL-QoL again demonstrated a similar significant association with all PROMs. Multiple regression did not demonstrate common demographic or operative variables that were significant predictors of PROMs. CONCLUSION: Following ACDF, patients experienced a worsening of dysphagia but resolved by 12 weeks. All PROMs demonstrated significant improvements by the 6-month timepoint, except for PHQ-9. SWAL-QoL demonstrated a significant effect on all postoperative outcomes, which may suggest that this questionnaire could effectively evaluate dysphagia and predict positive or negative outcomes following ACDF. LEVEL OF EVIDENCE: 3 CLINICAL RELEVANCE: The severity of dysphagia has a significant association with pain, disability, mental health, and physical function patient-reported outcome measures in patients undergoing ACDF.

BACKGROUND: Individual items within the Patient Health Questionnaire-9 (PHQ-9) have not been assessed as predictors of postoperative outcomes. Our objective is to study the relationship between responses to individual PHQ-9 items and achievement of a minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). METHODS: A prospective surgical database was reviewed for primary, single-level ACDF procedures performed for degenerative spinal pathology. Patient demographics, preoperative spinal pathology, and perioperative characteristics were recorded. Patient-reported outcome measures (PROMs) including PHQ-9, visual analog scale (VAS) neck and arm, Neck Disability Index, 12-item Short Form physical component score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System Physical Function were administered at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. MCID achievement was determined by comparing postoperative PROM improvement from baseline to previously established values. Logistic regression assessed responses to each individual question of the preoperative PHQ-9 as predictors of MCID achievement in each other PROMs. RESULTS: Sixty-six ACDF patients were included with a mean age of 47.2 years. Herniated nucleus pulposus was the most common preoperative spinal diagnosis (95.6%). The mean operative duration was 50.3 minutes, the mean estimated blood loss was 27.5 mL, and most patients were discharged on postoperative day 0 (81.8%). A majority of patients achieved MCID for all measures except SF-12 PCS. PHQ-9 question 3 significantly predicted MCID achievement for VAS neck (P = 0.045), VAS arm (P = 0.049), and SF-12 PCS (P = 0.037). No other PHQ-9 items or overall PHQ-9 scores significantly predicted MCID achievement. CONCLUSION: Question 3 of the PHQ-9 regarding “trouble falling asleep, staying asleep, or sleeping too much” significantly predicted clinically meaningful improvement in neck pain, arm pain, and physical function following ACDF, although overall PHQ-9 scores did not. Providers should inform patients experiencing significant sleep-related difficulties that they may be especially likely to benefit from ACDF surgery. CLINICAL RELEVANCE: Evaluation of sleep from the PHQ-9 predicts clinically relevant improvement in neck pain, arm pain, and physical function in patients undergoing ACDF. LEVEL OF EVIDENCE: 3.

STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to determine the impact of obesity on postoperative outcomes and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). SUMMARY OF BACKGROUND DATA Obesity is a proven risk factor for poorer outcomes in MIS TLIF patients. However, few studies have investigated the impact of body mass index (BMI) on achievement of a MCID for Patient-Reported Outcome Measurement Information System Physical Function (PROMIS PF). METHODS A prospective surgical database was retrospectively reviewed for primary, elective, single level MIS TLIF patients. Patients were categorized into BMI groups: nonobese (

INTRODUCTION Physical function evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS PF) instrument has been validated through the short-term postsurgical period in spine surgery patients. Evidence for long-term efficacy of PROMIS PF is lacking in lumbar decompression (LD) patients. The objective of this study was to evaluate correlations between PROMIS PF and legacy patient-reported outcome measures for patients undergoing LD. METHODS Consecutive primary or revision, single-level or multilevel LD surgeries were retrospectively reviewed from May 2015 to September 2017. Patients lacking preoperative or 2-year PROMIS PF scores were excluded. Demographics, baseline pathology, and perioperative characteristics were collected, and descriptive statistics performed. Visual Analogue Scale (VAS) back and leg, Oswestry Disability Index (ODI), 12-Item Short Form (SF-12) Physical Composite Score (PCS), and PROMIS PF were collected at preoperative and postoperative timepoints and evaluated for improvement from baseline values. Correlations between PROMIS PF and VAS back, VAS leg, SF-12 PCS, and ODI were calculated and categorized according to the strength of relationship. RESULTS Ninety-two patients were included in this study with 58.7% of LDs performed at the single level. All patient-reported outcome measures demonstrated significant improvement from baseline values at all assessment timepoints (all P < 0.001). Apart from preoperative VAS back and VAS leg, PROMIS PF demonstrated a significant and strong correlation with VAS back, VAS leg, ODI, and SF-12 PCS at all timepoints (all P < 0.001). CONCLUSION PROMIS PF demonstrated a strong correlation with pain, disability, and PF outcome measures throughout the postoperative period out to 2 years after LD. Our study provides longitudinal evidence that the PROMIS PF instrument is a valid measure for PF for patients undergoing LD.

Background: Patient selection and analgesic techniques, such as the multimodal analgesic (MMA) protocol, aid in ambulatory surgical center (ASC) cervical spine surgery. The purpose of this case series is to characterize patients undergoing anterior cervical discectomy and fusion (ACDF) and total cervical disc replacement (CDR) in an ASC with an enhanced MMA protocol. Methods: A prospectively maintained registry was retrospectively reviewed for cervical surgeries between May 2013 and August 2019. Inclusion criteria included ASC patients who underwent single-level or multilevel CDR or ACDF using an MMA protocol. Baseline, intraoperative, and postoperative characteristics were recorded, including length of stay, visual analog scale pain scores, neck disability index, complications, and narcotics administered. Results: A total of 178 patients met inclusion criteria with 125 single-level, 52 two-level, and 1 three-level procedure. Of those patients, 127 underwent ACDF and 51 underwent CDR. The longest procedure was 95 minutes and the mean length of stay was 6.1 hours, with 2 patients requiring hospital admission. All other patients were discharged within 10 hours. One of the admitted patients experienced a postoperative seizure that was later determined to be secondary to drug use and serotonin syndrome. The second patient developed an anterior cervical hematoma 5 hours postoperatively, which was immediately evacuated. The patient was admitted for observation and discharged the next day. Conclusion: In our study, patients experienced considerable improvement in disability scores, with a low likelihood of postoperative complications. A safe and effective MMA protocol may help facilitate anterior cervical surgery in the outpatient setting. Level of Evidence: 3. Clinical Relevance: Transitioning anterior cervical discectomy and fusions to the ASC requires an appropriate MMA protocol. Our findings reveal that an enhanced MMA protocol will help improve disability scores while keeping the likelihood of postoperative complications low. This supports the ASC setting for cervical spine procedures in appropriate patient populations.

Objective There is a scarcity of research evaluating gender differences in depressive symptoms among patients undergoing cervical surgery. This study investigated gender differences with regard to depressive symptom severity, measured by Patient Health Questionnaire-9 (PHQ-9), in patients following anterior cervical discectomy and fusion (ACDF) or artificial disc replacement (ADR). Methods A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries. Depressive symptom severity was evaluated by PHQ-9 at both preand postoperative timepoints (e.g. , 6 weeks, 12 weeks, 6 months, 1 year, and 2 years). A chi-square test and Student t-test evaluated differences between the gender for demographic and operative variables where appropriate. Differences between the gender subgroup mean PHQ-9 scores were assessed using a t-test pre- and postoperatively (e.g. , 6 weeks, 12 weeks, 6 months, and 1 year) and a paired t-test was used to assess differences from preoperative scores at each postoperative time point. Results A total of 170 subjects underwent 125 ACDFs and 45 ADRs. Both pre- and postoperative timepoints demonstrated no significant differences between mean PHQ-9 scores by gender. Female patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, and 12 weeks, but not through 2 years. Male patients demonstrated statistically significant improvement in PHQ-9 scores at 6 weeks, 12 weeks, 6 months, 1 year, and 2 years. Conclusion Although there were no significant differences between mean PHQ-9 score between the genders, there was a difference in magnitude of improvement. Females had a significant improvement in depressive symptom severity over baseline at the 6- and 12-week timepoints only, whereas males had significant improvement through 2 years postoperatively.

Objective Our study aims to evaluate the correlation of Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) with legacy patient-reported outcome measures (PROMs) among patients undergoing anterior cervical discectomy and fusion (ACDF). Methods A prospectively maintained database was retrospectively reviewed for ACDF surgeries performed between May 2015 and September 2017. Inclusion criteria were primary elective, single- or multilevel ACDFs for degenerative spinal pathology. Patients lacking preoperative or 2-year PROMIS PF surveys were excluded. Mean scores were calculated for visual analogue scale (VAS) neck, VAS arm, Neck Disability Index (NDI), 12-Item Short Form Physical Component Score (SF-12 PCS), and PROMIS PF at preoperative and 6-week, 12-week, 6-month, 1-year, and 2-year postoperative timepoints. A t-test and Pearson correlation coefficient were utilized to evaluate score improvement and PROM relationships respectively. Results The 50 subject cohort was 60.0% male, 50% obese (body mass index ≥ 30 kg/m2) and had an average age of 50.9 years. Significant improvements were demonstrated for VAS neck and NDI at all postoperative timepoints (p < 0.001) and for SF-12 and PROMIS PF at all timepoints except 6 weeks (p ≤ 0.025). VAS arm improvement was seen up to 1 year (p ≤ 0.016). PROMIS PF demonstrated strong correlations with NDI and SF-12 PCS at all evaluated timepoints and with VAS neck at all postoperative timepoints except 6 weeks (all p < 0.01). Conclusion PROMIS PF was strongly correlated with pain, disability, and physical function up to 2 years for patients undergoing ACDF. Our results support the long-term validity of PROMIS PF for measurement of patient-reported physical function among ACDF cohorts.

Patient-reported outcome measures (PROMs) are used to capture the true extent of postoperative improvement. Use of lengthier and repetitive PROMs can increase question burden on patients. This study aims to determine whether the length of time to complete (TTC) legacy PROMs has an impact on scores after lumbar decompression.A surgical database was retrospectively reviewed for patients who underwent primary, single-level lumbar decompression from 2013 to 2020. Demographic and perioperative characteristics were collected. Physical function (PF) was measured by 12-Item Short Form (SF-12), 12-Item Veterans RAND (VR-12), and Patient-Reported Outcomes Measurement Information System (PROMIS) and was collected preoperatively and postoperatively. TTC was calculated as the difference between start and ending times for each instance of survey completion. Improvements for PROMs and comparison of TTC between SF-12/VR-12 and PROMIS PF were evaluated using a t-test. Correlation between TTC and PROM scores was evaluated using the Pearson correlation. Impact of TTC on postoperative PROM scores was evaluated using linear regression.A total of 216 patients, of which 68.1% were men, were included with a mean age of 45.8 years. Mean postoperative TTC for SF-12 and VR-12 was significantly longer than preoperative values (all P0.05). No notable difference in TTC was demonstrated for PROMIS PF. TTC PROMIS PF was significantly shorter than SF-12 and VR-12 from 12 weeks through 1 year (all P0.050). A low-strength negative correlation of TTC with SF-12 and VR-12 was observed at the preoperative, 6-week and 1-year timepoint whereas PROMIS PF had a low-strength positive correlation with TTC preoperatively and at 6 months (all P0.05).Time spent completing PROMIS PF did not markedly differ postoperatively, but SF-12 and VR-12 required a longer TTC than PROMIS PF. Although insightful to patient improvement, SF-12 and VR-12 may increase the question burden placed on patients to complete surveys in a timely manner.

As more patients undergo lumbar spine surgery, novel interventions may improve physical and mental health outcomes. Few studies summarize the benefit of cognitive behavioral therapy (CBT) among lumbar spine surgery patients. This study collects randomized control trial data to investigate the influence of CBT on patient reported outcomes among lumbar spine surgery patients. Our study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and a medical library expert assisted in searching PubMed/MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Google Scholar. We calculated standardized mean differences (SMD) to evaluate the effect size of CBT versus control groups with a sensitivity analysis. Our meta-analysis included seven studies with a total of 531 patients. The majority of included studies evaluated lumbar fusion, with preoperative CBT performed by physiotherapists. The largest effects were observed for overall quality of life (SMD = 0.55 [95% CI 0.05, 1.05], p

STUDY DESIGN Retrospective. OBJECTIVE Evaluate the association between comorbidity burden and reaching minimum clinically important difference (MCID) following lumbar decompression (LD). SUMMARY OF BACKGROUND DATA There is limited research on the influence of preoperative comorbidity burden on patient-reported outcome improvement following LD. METHODS A prospectively maintained surgical registry was retrospectively reviewed for eligible spine surgeries between 2015 and 2019. Inclusion criteria were primary, single, or multilevel LD. Patients were excluded for missing preoperative patient-reported outcome surveys. Stratification was based on Charlson Comorbidity Index (CCI) score: 0 points (no comorbidities), 1-2 points (low CCI), ≥3 points (high CCI). Demographics and perioperative characteristics were evaluated for differences. Linear regression assessed postoperative improvement for visual analogue scale (VAS) back, VAS leg, Oswestry disability index (ODI), Short Form-12 Physical Composite Score (SF-12 PCS), and Patient-Reported Outcomes Measurement Information System physical function (PROMIS-PF) scores through 1 year. Achievement rate of MCID was compared between groups and evaluated for significant predictors. RESULTS Three hundred fourteen patients were included (123 no comorbidities, 100 low CCI, 91 high CCI). Higher CCI patients were older, more likely to smoke, and have comorbid diseases (all P

Study design Retrospective cohort. Objective To investigate and establish minimum clinically important differences (MCID) for Patient Health Questionnaire-9 (PHQ-9) among patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Summary of background Spine surgery is linked to postoperative improvements in anxiety, depression, and mental health. These improvements have been documented using patient-reported outcome measures such as PHQ-9. Few studies evaluated the clinical significance of PHQ-9 for lumbar spine surgery. Methods Patients who underwent single-level, primary MIS TLIF from 2015 to 2017 were retrospectively reviewed in a prospective database. Patients with incomplete preoperative and 2-year postoperative PHQ-9 surveys were excluded. Demographic and perioperative characteristics were recorded. PHQ-9, 12-Item Short Form (SF-12), and Veterans RAND 12-Item Health Survey (VR-12) Mental Component Summary (MCS) were collected at preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year intervals. MCID was calculated using anchor and distribution-based methods. SF-12 served as an anchor. MCID was assessed using mean change methodology, four receiver operating characteristic curve assessments, and standard error measurement. Cutoff values were selected from receiver operating characteristic curve analysis. MCID achievement rates for all patient-reported outcome measures were calculated. Results A total of 139 patients met inclusion criteria, with a mean age of 55 years and 39% females. The most common spinal pathology was radiculopathy (92%). MCID analysis revealed the following ranges of values: 2.0 to 4.8 (PHQ-9), 6.7 to 12.1 (SF-12 MCS), and 7.5 to 15.9 (VR-12 MCS). Final MCID thresholds were 3.0 (PHQ-9), 9.1 (SF-12 MCS), and 8.1 (VR-12 MCS). MCID achievement at 2-years for PHQ-9, SF-12 MCS, and VR-12 MCS was 89.2%, 85.6%, and 84.9% respectively. Conclusion Our 2-year postoperative MCID analysis is the first mental health calculation from an MIS TLIF cohort. We report a 2-year MCID value for PHQ-9 of 3.0 (2.0-4.8). MCID values for mental health instruments are important for determining overall success of lumbar spine surgery.Level of Evidence: 3.

BACKGROUND: The Altmetric (Digital Science, Holtzbrinck Publishing) Attention Score (AAS) is an automatically calculated score that accounts for other literary influences, which include academic sources as well as nonacademically focused social media outlets such as Twitter, Facebook, and news articles. This study compares the most popular cervical surgery articles on social media to the most cited articles within peer-reviewed literature and identifies journals that contribute the most articles and geographic trends. METHODS: We searched the Altmetric database for cervical spine surgery articles since inception using the search phrase “cervical” and “spine.” We ranked journals that contributed the most articles and calculated their AAS, contributing social media outlets (eg, Twitter, Facebook, News, etc) and citation counts. We also ranked the top 100 most popular cervical spine articles on social media and compared them to the most cited articles. Countries were assessed based on their mentions through the most contributing social media platform. RESULTS: Of the 527 total journals identified in our search, the top 10 journals were responsible for contributing 60.2% of the total articles. The 3 journals that contributed the most articles were Spine (18.9%), European Spine Journal (11.8%), and The Spine Journal (10.3%). The journals with the highest AAS scores included Journal of Neurosurgery: Spine (11.3), Spine (8.8), and Journal of Manipulative & Physiological Therapeutics (5.8). Social media outlets that contributed the most mentions per article were Twitter (4.4), Facebook (0.5), and news sources (0.3). Among all countries contributing Twitter mentions, the 3 countries with the most cervical spine posts included the United States (23.3%), the United Kingdom (10.3%), and Spain (5.5%). CONCLUSION: Our evaluation of cervical spine literature revealed Twitter, Facebook, and news sources are the most common social media outlets influencing title dissemination. Journals contributing the most articles did not necessarily have the highest average AAS. CLINICAL RELEVANCE: Spinal surgeons should consider utilization of social media outlets, such as Twitter, Facebook, and news sources, to potentially increase the dissemination of their articles. LEVEL OF EVIDENCE: 3.

STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The purpose of this study is to examine whether the time duration from symptom onset to operative treatment is associated with postoperative clinical improvement after anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA There is a paucity of literature regarding the influence of preoperative symptom duration on patient-reported outcomes (PROs) following ACDF. METHODS Patients who underwent primary, single-level ACDF were retrospectively reviewed and stratified according to preoperative symptom duration (

BACKGROUND: Body mass index (BMI) serves as a risk factor for complications and poorer outcomes following anterior cervical discectomy and fusion (ACDF). This study investigates the association between BMI and Patient Reported Outcomes Measurement Information System physical function (PROMIS-PF) following ACDF. METHODS: A prospectively maintained surgical registry was retrospectively reviewed for cervical spine surgeries between 2015 and 2019. Included patients underwent elective primary, single, or multilevel ACDF and were excluded for missing preoperative PROMIS-PF. Patients were stratified into 4 groups based on BMI score. Associations of demographic and perioperative characteristics with BMI groups were analyzed using either χ(2) test or t test. PROMIS-PF was evaluated preoperatively and 6 weeks, 12 weeks, 6 months, 1 year, and 2 years postoperatively using linear regression. Delta improvement in PROMIS-PF was evaluated at all time points. RESULTS: The 128 study cohort had 74 patients the nonobese, 27 in the Obese I, 19 in the Obese II, and 8 in the Obese III groups. The mean age was 50.0 years and 57.0% were male. Gender, diabetic status, and Charlson Comorbidity Index (CCI) significantly differed by BMI groups but did not differ by perioperative characteristics. Preoperative PROMIS-PF did not significantly differ by group. Obese II and III groups had decreased PROMIS-PF compared to Obese I and nonobese groups at 1 year and 2 years. BMI groups had significantly different delta improvement at the 12 weeks (4.1 vs 10.1 vs 1.8 vs 4.3; P = 0.044) and 2 years (9.9 vs 7.1 vs 2.3 vs 3.0; P = 0.048). CONCLUSION: Among the assessed BMI subgroups, all experienced similar physical function scores during the preoperative and short-term time points. Patients with higher BMI demonstrated diminished physical function at long-term time points. While this study focused on evaluating obesity, longitudinal tracking of high-risk patients during the postoperative period remains important for optimal rehabilitation. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: High BMI may predispose patients to lengthier recovery of physical function following ACDF.

To conduct a comprehensive systematic review and meta-analysis of current retrospective cohort studies to identify significant preoperative risk factors for prolonged postoperative opioid use following spine surgery.Studies were identified according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses through a search of PubMed, Google Scholar, Scopus, and Cochrane databases. Unique articles were screened by 2 independent reviewers. Primary research articles reporting odds ratios of risk factors for prolonged opioid use following spine surgery were included. Prolonged opioid use was defined as continued use ≥3 months following surgery, and study quality was evaluated using the Newcastle-Ottawa Scale. Random-effects meta-analysis was performed to calculate pooled odds ratios and confidence intervals.The initial search yielded 648 studies. Following duplicate removal, 492 titles and abstracts were screened. After full-text review of 68 studies, 19 final studies including 168,961 patients were eligible for meta-analysis. Newcastle-Ottawa Scale scores ranged from 6 to 9. Meta-analysis assessed 17 risk factors for long-term opioid use. Preoperative opioid use, depression, depression and/or anxiety, drug abuse or dependency, female gender, fibromyalgia, lower back pain, tobacco use, and chronic pulmonary disease were found to be statistically significant risk factors for prolonged opioid use.Several patient-level factors may play a role in the tendency to persistently use opioids after spine surgery. By preoperatively identifying these characteristics, clinicians may be better able to identify patients who are at risk and employ methods to mitigate potential long-term opioid use.