Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Clin Spine Surg. 2024 Jul 1;37(6):E239-E244. doi: 10.1097/BSD.0000000000001560. Epub 2024 Jan 8.
Retrospective cohort study.
To assess the impact of preoperative symptom duration (PSD) on patient-reported outcome measures (PROMs) after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative spondylolisthesis (DSpond).
A prolonged duration of preoperative symptoms may implicate inferior long-term outcomes postsurgery. Prior studies of lumbar fusion recipients are limited by the inclusion of heterogeneous populations.
A single-surgeon registry was retrospectively queried for privately insured patients who had undergone primary, elective, single-level MIS-TLIF for DSpond with a recorded symptom start date. Cohorts were formed by PSD: shorter duration (PSD <1 y) or greater duration (GD; PSD ≥1 y). PROMs evaluated included Patient-reported Outcomes Measurement Information System-Physical Function, Oswestry Disability Index, Visual Analog Scale-Back, Visual Analog Scale-Leg, and 9-item Patient Health Questionnaire. The magnitude of PROM (∆PROM) improvement from preoperative baseline to 6 weeks and final follow-up (∆PROM-FF) were compared between cohorts. Intercohort achievement rates of a minimum clinically important difference in each PROM were compared.
A total of 133 patients included 85 patients with GD cohort. There were no significant differences in pre hoc demographics and perioperative characteristics between cohorts, as well as preoperative, 6-week, or final follow-up PROMs between cohorts. Both cohorts demonstrated significant improvement in all PROMs at 6 weeks and final follow-up ( P ≤ 0.049, all). There were no significant intercohort differences demonstrated in minimum clinically important difference achievement rates, ∆PROM-6W, or ∆PROM-FF in any PROM.
Regardless of the symptom duration before MIS-TLIF for DSpond, patients demonstrate significant improvement in physical function, pain, disability, and mental health. Patients with a GD of preoperative symptoms did not report inferior scores in any PROM domain. Patients with a GD of preoperative symptoms did not suffer inferior rates of clinically meaningful improvement after surgical intervention. These findings should be considered when counseling patients before surgical intervention for DSpond.
回顾性队列研究。
评估术前症状持续时间（PSD）对退行性脊柱滑脱（DSpond）微创经椎间孔腰椎体间融合术（MIS-TLIF）后患者报告的结果测量（PROM）的影响。
术前症状持续时间延长可能意味着术后长期预后较差。先前腰椎融合术受者的研究受到纳入异质人群的限制。
对接受过原发性、择期、单节段 MIS-TLIF 治疗 DSpond 且有记录的症状起始日期的私人保险患者，对单一外科医生的注册处进行了回顾性查询。根据 PSD 分为两个队列：较短的持续时间（PSD<1 年）或较长的持续时间（PSD≥1 年）。评估的 PROM 包括患者报告的测量信息系统-身体功能、Oswestry 残疾指数、视觉模拟量表-背部、视觉模拟量表-腿部和 9 项患者健康问卷。比较两组之间从术前基线到 6 周和最终随访（PROM-FF）的 PROM 改善幅度（PROM-6W）。比较每个 PROM 中最小临床重要差异的达成率。
共有 133 例患者，其中 85 例为 GD 队列。两组在术前人口统计学和围手术期特征、以及各队列之间的术前、6 周和最终随访 PROM 方面均无显著差异。两组在所有 PROM 方面均在 6 周和最终随访时表现出显著改善（P≤0.049，均）。在任何 PROM 中，最小临床重要差异达成率、PROM-6W 或 PROM-FF 均无显著的组间差异。
无论 DSpond 患者接受 MIS-TLIF 前的症状持续时间如何，患者的身体功能、疼痛、残疾和心理健康均有显著改善。术前症状持续时间较长的患者在任何 PROM 领域的评分均无降低。在接受手术干预后，术前症状持续时间较长的患者在临床上有意义的改善率并不低。在为 DSpond 患者提供手术干预前咨询时，应考虑这些发现。
