Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA.
Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY , USA.
Spine J. 2023 Jan;23(1):54-63. doi: 10.1016/j.spinee.2022.07.087. Epub 2022 Jul 15.
Surgical counseling enables shared decision-making (SDM) by improving patients' understanding.
To provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery.
Retrospective review of prospectively collected data.
Patients who underwent primary tubular minimally invasive lumbar spine surgery in form of transforaminal lumbar interbody fusion (MI-TLIF), decompression alone, or microdiscectomy and had a minimum of 1-year follow-up.
(1) Surgical (radiation exposure and intraoperative complications) (2)Immediate postoperative (length of stay [LOS] and complications) (3) Clinical outcomes (Visual Analog Scale- back and leg, VAS; Oswestry Disability Index, ODI; 12-Item Short Form Survey Physical Component Score, SF-12 PCS; Patient-Reported Outcomes Measurement Information System Physical Function, PROMIS PF; Global Rating Change, GRC; return to activities; complications/reoperations) METHODS: The outcome measures were analyzed to provide answers to ten FAQs that were compiled based on the authors' experience and a review of literature. Changes in VAS back, VAS leg, ODI, and SF-12 PCS from preoperative values to the early (<6 months) and late (>6 months) postoperative time points were analyzed with Wilcoxon Signed Rank Tests. % of patients achieving minimal clinically important difference (MCID) for these patient-reported outcome measures (PROMs) at the two time points was evaluated. Changes in PROs from preoperative values too early (<6 months) and late (≥6 months) postoperative time points were analyzed within each of the three groups. Percentage of patients achieving MCID was also evaluated.
Three hundred sixty-six patients (104 TLIF, 147 decompression, 115 microdiscectomy) were included. The following FAQs were answered: (1) Will my back pain improve? Most patients report improvement by >50%. About 60% of TLIF, decompression, and microdiscectomy patients achieved MCID at ≥6 months. (2) Will my leg pain improve? Most patients report improvement by >50%. 56% of TLIF, 67% of decompression, and 70% of microdiscectomy patients achieved MCID at ≥6 months. (3) Will my activity level improve? Most patients report significant improvement. Sixty-six percent of TLIF, 55% of decompression, and 75% of microdiscectomy patients achieved MCID for SF-12 PCS. (4) Is there a chance I will get worse? Six percent after TLIF, 14% after decompression, and 5% after microdiscectomy. (5) Will I receive a significant amount of radiation? The radiation exposure is likely to be acceptable and nearly insignificant in terms of radiation-related risks. (6) What is the likelihood that I will have a complication? 17.3% (15.4% minor, 1.9% major) for TLIF, 10% (9.3% minor and 0.7% major) for decompression, and 1.7% (all minor) for microdiscectomy (7) Will I need another surgery? Six percent after TLIF, 16.3% after decompression, 13% after microdiscectomy. (8) How long will I stay in the hospital? Most patients get discharged on postoperative day one after TLIF and on the same day after decompression and microdiscectomy. (9) When will I be able to return to work? >80% of patients return to work (average: 25 days after TLIF, 14 days after decompression, 11 days after microdiscectomy). (10) Will I be able to drive again? >90% of patients return to driving (average: 22 days after TLIF, 11 days after decompression, 14 days after microdiscectomy).
These concise answers to the FAQs in minimally invasive lumbar spine surgery can be used by physicians as a reference to enable patient education.
手术咨询通过提高患者的理解能力来促进共同决策（SDM）。
为微创腰椎手术提供常见问题解答（FAQ）。
前瞻性收集数据的回顾性研究。
接受经椎间孔腰椎体间融合术（MI-TLIF）、单纯减压或显微椎间盘切除术的原发性管状微创腰椎手术，且至少随访 1 年的患者。
（1）手术（辐射暴露和术中并发症）（2）术后即刻（住院时间 [LOS] 和并发症）（3）临床结果（VAS-背、VAS-腿、ODI、12 项简明健康调查量表物理成分评分 [SF-12 PCS]、患者报告的结果测量信息系统物理功能 [PROMIS PF]、总体评分变化、恢复活动、并发症/再次手术）
分析结果测量值，以回答根据作者经验和文献综述编写的十个 FAQ。使用 Wilcoxon 符号秩检验分析从术前值到早期（<6 个月）和晚期（>6 个月）术后时间点的 VAS 背、VAS 腿、ODI 和 SF-12 PCS 的变化。评估这些患者报告的结果测量值（PROMs）在两个时间点上达到最小临床重要差异（MCID）的患者比例。在每组内分析从术前值到早期（<6 个月）和晚期（≥6 个月）术后时间点的 PROs 的变化。还评估了达到 MCID 的患者比例。
共纳入 366 例患者（TLIF 组 104 例、减压组 147 例、显微椎间盘切除术组 115 例）。回答了以下 FAQ：（1）我的背痛会改善吗？大多数患者报告改善>50%。TLIF、减压和显微椎间盘切除术患者约 60%在≥6 个月时达到 MCID。（2）我的腿痛会改善吗？大多数患者报告改善>50%。TLIF 组 56%、减压组 67%和显微椎间盘切除术组 70%的患者在≥6 个月时达到 MCID。（3）我的活动水平会提高吗？大多数患者报告有显著改善。TLIF 组 66%、减压组 55%和显微椎间盘切除术组 75%的患者达到 SF-12 PCS 的 MCID。（4）我有恶化的可能吗？TLIF 后 6%、减压后 14%、显微椎间盘切除术后 5%。（5）我会接受大量辐射吗？辐射暴露可能是可以接受的，并且从辐射相关风险的角度来看几乎可以忽略不计。（6）我有发生并发症的可能性有多大？TLIF 组为 17.3%（15.4%为轻微并发症，1.9%为严重并发症），减压组为 10%（9.3%为轻微并发症，0.7%为严重并发症），显微椎间盘切除术组为 1.7%（均为轻微并发症）（7）我需要再做手术吗？TLIF 后 6%、减压后 16.3%、显微椎间盘切除术后 13%。（8）我要住院多久？大多数患者在 TLIF 后第一天出院，减压和显微椎间盘切除术后同一天出院。（9）我什么时候能回去工作？>80%的患者（平均：TLIF 后 25 天、减压后 14 天、显微椎间盘切除术后 11 天）返回工作岗位。（10）我什么时候能开车？>90%的患者（平均：TLIF 后 22 天、减压后 11 天、显微椎间盘切除术后 14 天）可以开车。
这些微创腰椎手术常见问题解答的简洁答案可作为医生进行患者教育的参考。
