Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
Central Michigan University College of Medicine, 1280 S. East Campus Dr, Mount Pleasant, MI 48859, United States.
J Clin Neurosci. 2024 Dec;130:110889. doi: 10.1016/j.jocn.2024.110889. Epub 2024 Oct 24.
As lateral lumbar interbody fusions (LLIF) are increasingly performed, our understanding of postoperative clinical trajectories is important in informing preoperative patient expectations. While minimum clinically important difference (MCID) rates are widely utilized in spine surgery literature, there is less published on how long it takes for patients to achieve MCID following LLIF.
To evaluate the length of time it takes for patients to report MCID achievement for back pain, leg pain, disability, and physical function and evaluate predictors of time to achieve MCID.
Patients undergoing elective LLIF by the senior author with baseline and postoperative patient-reported outcomes (PROs) recorded were retrospectively identified. Data on potential predictors of time to MCID achievement were gathered including demographics, comorbidities, diagnostic information, and baseline PROs. MCID achievement rates for Oswestry Disability Index (ODI), Visual Analog Scale-Back (VAS-Back), VAS-Leg, and Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF) were calculated at six-, twelve, 6 month- 1 year- and 2-year postoperative timepoints. A Kaplan-Meier survival analysis was conducted to determine the proportion of patients achieving MCID at each time point. A multivariate Cox regression determined predictors of time to MCID achievement.
One hundred-five patients were included in the analysis. The mean time to achieve MCID for PROMIS-PF was 44.7 weeks, for VAS-Back was 38.5 weeks, for VAS-Leg was 36.7 weeks, and for ODI was 38.3 weeks. Worse baseline VAS-Back significantly predicted earlier MCID achievement for VAS-Back (HR: 1.55), while diabetes was predictive of later MCID achievement (HR: 0.21). Higher body mass index and worse preoperative ODI predicted earlier MCID achievement for ODI (HR: 1.04-1.08), and higher VAS-Leg score and two-level fusion were predictive of later MCID achievement for ODI, (HR:0.26-0.81). Worse preoperative VAS-Leg, isthmic spondylolisthesis, and three-level fusion were predictors of earlier achievement of MCID for VAS-Leg (HR: 1.27-6.47). Herniated nucleus pulposus and foraminal stenosis were early predictors (HR: 2.92-3.23) and workers' compensation was a late predictor of MCID attainment for PROMIS-PF (HR: 0.13).
Select demographic variables, comorbidities, spinal pathology, and preoperative PROs influenced the time it took for patients to report clinically significant improvements in pain, disability, and physical function scores. These findings can be used to prognosticate outcomes for patients undergoing LLIF and inform patient expectations of postoperative recovery.
随着侧方腰椎体间融合术（LLIF）的应用日益增多，了解术后临床轨迹对于告知患者术前预期非常重要。虽然最小临床重要差异（MCID）率在脊柱外科文献中得到了广泛应用，但对于患者在接受 LLIF 后需要多长时间才能达到 MCID 却知之甚少。
评估患者报告腰痛、腿痛、残疾和身体功能达到 MCID 的时间，并评估达到 MCID 的时间的预测因素。
回顾性分析由资深作者进行的择期 LLIF 患者，记录基线和术后患者报告的结局（PROs）数据。收集了与达到 MCID 时间相关的潜在预测因素的数据，包括人口统计学、合并症、诊断信息和基线 PROs。在术后 6 周、12 周、6 个月-1 年和 2 年时，计算 Oswestry 残疾指数（ODI）、视觉模拟量表-背部（VAS-Back）、VAS-腿部和患者报告的结局测量信息系统-身体功能（PROMIS-PF）的 MCID 达标率。采用 Kaplan-Meier 生存分析确定每个时间点达到 MCID 的患者比例。采用多变量 Cox 回归确定达到 MCID 时间的预测因素。
105 例患者纳入分析。达到 PROMIS-PF 的 MCID 的平均时间为 44.7 周，达到 VAS-Back 的 MCID 的平均时间为 38.5 周，达到 VAS-腿部的 MCID 的平均时间为 36.7 周，达到 ODI 的 MCID 的平均时间为 38.3 周。基线 VAS-Back 更差显著预测 VAS-Back 的 MCID 更早达到（HR：1.55），而糖尿病则预测 MCID 更晚达到（HR：0.21）。较高的 BMI 和更差的术前 ODI 预测 ODI 的 MCID 更早达到（HR：1.04-1.08），较高的 VAS-腿部评分和双节段融合预测 ODI 的 MCID 更晚达到（HR：0.26-0.81）。基线 VAS-腿部更差、峡部裂性腰椎滑脱和三节段融合是 VAS-腿部 MCID 更早达到的预测因素（HR：1.27-6.47）。椎间盘突出症和椎间孔狭窄症是早期预测因素（HR：2.92-3.23），工人赔偿是 PROMIS-PF 达到 MCID 的晚期预测因素（HR：0.13）。
选择人口统计学、合并症、脊柱病理和术前 PROs 等因素影响了患者报告疼痛、残疾和身体功能评分达到临床显著改善的时间。这些发现可用于预测接受 LLIF 治疗的患者的结局，并告知患者对术后康复的预期。
