Patel Madhav Rajesh, Jacob Kevin Chacko, Amin Kanhai S, Ribot Max A, Pawlowski Hanna, Prabhu Michael C, Vanjani Nisheka Navin, Singh Kern
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
Asian Spine J. 2023 Feb;17(1):96-108. doi: 10.31616/asj.2021.0388. Epub 2022 Aug 23.
This was a retrospective cohort study.
This study investigated the influence of preoperative mental health on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) among workers' compensation (WC) recipients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
No studies have evaluated the impact of preoperative mental functioning on outcomes following MIS TLIF among WC claimants.
WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology.
The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months SF-12 MCS, 12-weeks/6-months VAS back, 12-week VAS leg, and preoperative to 6-months ODI (p≤0.029, all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004).
Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1-2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health.
这是一项回顾性队列研究。
本研究调查了术前心理健康对接受微创经椎间孔腰椎椎间融合术（MIS TLIF）的工伤赔偿（WC）受助者的患者报告结局指标（PROMs）和最小临床重要差异（MCID）的影响。
尚无研究评估术前心理功能对WC索赔者MIS TLIF术后结局的影响。
确定接受单节段MIS TLIF的WC受助者。采用视觉模拟量表（VAS）评估背部和腿部疼痛、Oswestry功能障碍指数（ODI）、12项简短形式身体和心理综合量表（SF-12 PCS/MCS）以及患者报告结局测量信息系统身体功能，在术前/术后对受试者进行评估。根据术前SF-12 MCS将受试者分组：<41 vs.≥41。使用推断统计比较人口统计学/围手术期变量、PROMs和MCID。采用多元回归分析来解释脊柱病理的差异。
SF-12 MCS<41组和SF-12 MCS≥41组分别包括48例和45例患者。除6个月时外，在所有时间点，SF-12 MCS的PROMs变化均存在显著差异（所有p≤0.041）。SF-12 MCS<41组术前至6个月的SF-12 MCS、12周/6个月的VAS背部评分、12周的VAS腿部评分以及术前至6个月的ODI均较差（所有p≤0.029）。SF-12 MCS<41组在总体ODI以及6周/1年/总体SF-12 MCS方面的MCID达成情况更好（所有p≤0.043）；SF-12 MCS≥41组在6个月VAS背部评分方面的达成情况更好（p=0.004）。
较差的心理功能对接受腰椎融合术的WC受助者的基线和术后中期心理健康、背痛及残疾相关的生活质量结局产生不利影响。然而，术后1至2年的结局并无差异。虽然疼痛和身体功能的MCID达成情况在很大程度上不受术前心理健康评分的影响，但基线心理健康较差的WC受助者在残疾和心理健康方面总体临床意义上的改善率更高。
