Background
The minimum clinically important difference (MCID) has not been established in lateral lumbar interbody fusion (LLIF). Our study aims to establish MCID for patient-reported outcome ...measures (PROMs) of physical function and pain for LLIF through anchor-based and distribution-based approaches.
Methods
Patients undergoing LLIF with preoperative and 6-month postoperative Oswestry Disability Index (ODI) scores were identified. PROMs of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Component Score (SF-12 PCS), Veterans RAND 12-Item Short Form Physical Component Score (VR-12 PCS), visual analog scale (VAS) back, and VAS leg were collected at preoperative and 6-month postoperative time points. Anchor-based MCID calculations were average change, minimal detectable change, change difference, receiver operating characteristic curve, and cross-sectional analysis using ODI as the anchor. Distribution-based calculations were standard error of measurement, reliable change index, effect size, and 0.5 ∗ ΔSD.
Results
Fifty patients were included. Anchor-based approaches MCID ranges were PROMIS-PF 1.1–9.6, SF-12 PCS 6.4–16.5, VR-12 PCS 5.9–12.9, VAS Back 1.4–4.6, and VAS Leg 1.3–4.3. The area under curve for receiver operating characteristics (ROC) analysis ranged from 0.63 to 0.71. Distribution-based MCID ranges were PROMIS-PF 1.4–4.5, SF-12 PCS 1.9–12.7, VR-12 PCS 2.0–6.6, VAS Back 0.4–1.4, and VAS Leg 0.5–2.0.
Conclusion
MCID thresholds varied widely depending on the calculation method. The closest to (0,1) ROC approach was the most clinically appropriate MCID calculation. The corresponding MCID values for LLIF were PROMIS-PF at 7.8, SF-12 PCS at 6.4, VR-12 PCS at 9.3, VAS Back at 4.6, and VAS Leg at 4.3.
Background
Studies have demonstrated the influence of preoperative mental health on outcomes following spine surgery, but prior literature has not assessed the influence of mental health at time of ...outcome survey collection.
Methods
Patients who underwent elective anterior lumbar interbody fusion (ALIF) were identified from a prospective registry. Patient-reported outcomes (PROs) were collected preoperatively and up to 1 year postoperatively. Mental health measures studied included 12-item Short Form (SF-12) Mental Component Score (MCS) and Patient Health Questionnaire-9 (PHQ-9). Patient-Reported Outcome Measurement Information System-Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) back and leg pain, and Oswestry Disability Index (ODI) were compared to the mental health measures by Pearson’s correlation tests.
Results
A total of 166 patients were included. SF-12 MCS demonstrated positive correlation to PROMIS-PF preoperatively (|
r
|= 0.379) and at 6 weeks (|
r
|= 0.387) (
p
≤ 0.016, all). SF-12 MCS demonstrated negative correlation to VAS back at 6 months (|
r
|= 0.359), VAS leg at 6 weeks (|
r
|= 0.475) and 12 weeks (|
r
|= 0.422), and ODI up to 6 months postoperatively (|
r
|= 0.417–0.526) (
p
≤ 0.037, all). PHQ-9 negatively correlated with PROMIS-PF at all periods studied (|
r
|= 0.425–0.587) and SF-12 PCS up to 6 months postoperatively (|
r
|= 0.367–0.642) (
p
≤ 0.016, all). PHQ-9 positively correlated to VAS back at 6 weeks (|
r
|= 0.408) and 6 months (|
r
|= 0.411), VAS leg at 6 weeks (|
r
|= 0.344), and ODI up to 6 months postoperatively (|
r
|= 0.321–0.669) (
p
≤ 0.034, all).
Conclusion
Inferior mental health correlated with inferior pain, function, and disability scores at one or more periods postoperatively. This finding was most consistent for correlation between mental health scores and disability. Optimization of mental health may positively influence outcomes, especially regarding disability, following ALIF.
To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression.
Patients ...undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively.
Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain.
Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement.
We aim to compare the postoperative clinical outcomes, through patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID), in patients undergoing cervical disc ...replacement (CDR) with preoperative predominant neck pain (pNP) or arm pain (pAP).
Patients undergoing primary CDR were separated into pNP or pAP cohorts. Demographic, perioperative characteristics, PROMs at preoperative and postoperative time points, and MCID were compared using inferential statistics. Assessed PROMs included Patient-Reported Outcome Measurement Information System–Physical Function (PROMIS-PF), 12-Item Short Form Physical/Mental Component Score (SF-12 PCS/MCS), visual analog scale (VAS) neck, VAS arm, and Neck Disability Index.
There were a total of 84 patients, with 54 patients in the pNP cohort. The pNP cohort showed significant postoperative improvement in all PROMs, except for 6-week and 1-year SF-12 PCS, 1-year SF-12 MCS, and 6-month VAS arm score (P ≤ 0.023, all). The pAP cohort showed significant postoperative improvement in all PROMs, apart from 6-month to 1-year SF-12 PCS, and all SF-12 MCS (P ≤ 0.041, all). Greater MCID achievement rates were found in the pNP cohort for SF-12 MCS (P = 0.030). The pAP cohort had higher MCID achievement rates in VAS arm score and Neck Disability Index (P ≤ 0.046, all).
Independent of predominant pain location, patients reported improved physical function, pain, and disability outcomes. Patients with pNP had higher MCID achievement rates in mental function. Patients with pAP had higher rates of MCID achievement in arm pain and disability outcomes. Considering the predominant location of preoperative pain may be helpful in managing expectations for patients undergoing CDR.
Newer Patient-Reported Outcomes (PROs) may offer benefits over legacy PROs in ease of administration and interpretation. We aim to study the influence of preoperative pain interference (PI) using the ...Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) on postoperative clinical outcomes in patients undergoing lumbar decompression.
Patients undergoing lumbar decompression without fusion were separated into 2 cohorts: PROMIS-PI < 64 (lesser PI) and PROMIS-PI ≥ 64 (greater PI). PROs included PROMIS physical function, PROMIS anxiety (PROMIS-A), PROMIS sleep disturbance (PROMIS-SD), PROMIS-PI, Patient Health Questionnaire-9, Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) and were collected at preoperative and postoperative time points. Demographics, perioperative characteristics, PROs, and Minimum Clinically Important Difference (MCID) were compared among groups through non-parametric inferential statistics.
One-hundred and seven patients were identified. Independent of preoperative PI, patients reported significant postoperative improvement in PROMIS physical function, PROMIS-A, PROMIS-PI, VAS back, VAS leg, and ODI. The greater PI cohort reported significant postoperative improvement in Patient Health Questionnaire-9 and PROMIS-SD. The lesser PI cohort reported superior preoperative PROs in all domains. Postoperatively, the lesser PI cohort reported superior 6-week PROMIS-A and PROMIS-SD. MCID achievement rates were higher in the greater PI cohort for PROMIS-PI, VAS back, VAS leg, and ODI.
Patients with lower preoperative PI reported superior postoperative anxiety and sleep disturbance. Patients with greater preoperative PI had higher MCID achievement rates in PI, pain, and disability. Patients with greater preoperative PI undergoing lumbar decompression may demonstrate higher rates of clinically tangible improvement.
The modality of intraoperative neuromonitoring (IONM) in lateral approaches for interbody fusion varies. We aim to examine the types of neuromonitoring used in lateral approaches for lumbar interbody ...fusion and associated neurologic complications.
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. PubMed and Embase databases were searched from inception to July 2022 for articles examining lateral approaches for lumbar interbody fusion of lateral lumbar interbody fusion (LLIF) or oblique lateral interbody fusion (OLIF) with IONM modalities. Lateral approaches for lumbar interbody fusion with/without IONM was included. Articles without original patient data, case reports with fewer than 2 patients, non-English articles, nonlateral procedures, and nonhuman studies were excluded. The Risk of Bias in Non-randomized Studies–of Interventions tool was used to assess for bias.
A total of 34 studies were included. Twenty LLIF articles had IONM, whereas 1 LLIF article did not have IONM. Three OLIF articles specified IONM, whereas 6 OLIF articles did not have IONM. Two articles had patients undergoing either LLIF or OLIF. For LLIF, overall neurologic complications, motor weakness, and sensory deficits were 19.8%, 7.6%, and 10.6%, respectively. OLIF overall neurologic complications, motor weakness, and sensory deficits were 5.9%, 2.9%, and 3.2%, respectively. Neurologic outcomes with IONM were not superior compared to without IONM in either LLIF or OLIF.
Neurologic complication rates in LLIF remain high despite utilization of IONM. Use of IONM did not benefit neurologic outcomes. More prospective studies with different IONM modalities and without IONM are needed before determining specific benefits or shortcomings of each IONM modality.
Purpose
This study aims to assess the correlation between the patient-reported mental health and the self-reported outcome measures (PROMs) physical function, pain, and disability at different time ...points following disc replacement (CDR).
Methods
A single-surgeon registry was searched for patients who had undergone CDR, excluding those with indication for infection, cancer, or trauma. One hundred fifty-one patients were included. PROMs were collected preoperatively as well as 6 weeks, 3 months, 6 months, and 1 year postoperatively. Mental health measures evaluated included 12-Item Short Form (SF-12), Mental Component Score (MCS), and Patient Health Questionnaire-9 (PHQ-9) which were individually assessed via Pearson’s correlation tests in relation to Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), SF-12 Physical Component Score (PCS), visual analog scale (VAS) neck and arm pain, and Neck Disability Index (NDI).
Results
SF-12 MCS positively correlated with PROMIS-PF (range:
r
= 0.369–0.614) and SF-12 PCS (range:
r
= 0.208–0.585) with significance found at two or more time points for each (
p
≤ 0.009, all). SF-12 MCS negatively correlated with VAS neck (range:
r
= − 0.259 to − 0.464), VAS arm (range:
r
= − 0.281 to − 0.567), and NDI (range:
r
= − 0.474 to − 831) with significance found at three or more time points (
p
≤ 0.028, all). PHQ-9 significantly negatively correlated with PROMIS-PF (range:
r
= − 0.457 to − 0.732) and SF-12 PCS (range:
r
= − 0.332 to − 0.629) at all time points (
p
≤ 0.013, all). PHQ-9 positively correlated with VAS neck (range:
r
= 0.351–0.711), VAS arm (range:
r
= 0.239–0.572), and NDI (range:
r
= 0.602–0.837) at four or more periods (
p
≤ 0.032, all).
Conclusion
Patients undergoing CDR who reported lower mental health scores via either SF-12 MCS or PHQ-9 were associated with increased perception of pain and disability. Disability level correlated with mental health at all time periods. Patients with optimized mental health may report higher outcome scores following CDR.
Few studies have examined the influence of preoperative disability through the Oswestry Disability Index (ODI) on clinical outcomes in patients undergoing anterior lumbar interbody fusion (ALIF).
...Patients undergoing ALIF were separated into 2 groups based on ODI<41 (lower disability) versus ODI≥41% (higher disability). Patient-reported outcomes (PROs) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year/2-year time points. Physical function PROs were Patient-Reported Outcomes Measurement Information System Physical Function and 12-item Short Form Physical Component Score. Mental function PROs were 12-item Short Form Mental Component Score and Patient Health Questionnaire-9. Pain PROs were visual analog scale back and visual analog scale leg. ODI was the disability PRO.
A total of 148 patients were identified, with 52 patients with lower disability. Higher disability patients demonstrated significant improvement in mental function (P ≤ 0.010, all). Lower disability patients demonstrated superior postoperative PROs in physical function, mental function, back pain, and disability outcomes (P ≤ 0.034, all). Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower for mental function and disability outcomes (P ≤ 0.041, all).
Independent of preoperative disability, patients undergoing ALIF reported significant postoperative improvement in physical function, pain, and disability outcomes. Patients with lower preoperative disability continued to report superior PROs in mental function, back pain, and disability postoperatively. Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower in mental function and disability outcomes. Patients undergoing ALIF with higher preoperative disability may experience greater clinically meaningful improvement in mental function and disability.
Background
There is a scarcity of literature that examines clinical outcomes through patient-reported outcomes (PROs), minimum clinically important difference (MCID), and recovery ratios (RR) for ...workers’ compensation (WC) recipients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus anterior lumbar interbody fusion (ALIF).
Methods
WC claimants undergoing MIS-TLIF versus ALIF were propensity score matched to account for demographic differences. Demographics, perioperative characteristics, and PROs were collected. PROs of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form Physical Composite Score (SF-12 PCS), Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) were collected at preoperative and postoperative time points. MCID achievement was determined through comparison to values in literature. RR was calculated as the difference between postoperative and preoperative PROs over potential improvement. Comparison between surgical techniques was through non-parametric inferential statistics.
Results
Eighty-four WC claimants, with 50 patients undergoing MIS-TLIF, were identified after propensity score matching. ALIF patients had higher estimated blood loss. MIS-TLIF patients had higher postoperative day (POD) 0 VAS pain and POD 0 + 1 narcotic consumption. Patients undergoing either MIS-TLIF or ALIF reported significant improvement in pain and disability. ALIF patients reported significant improvement in physical function. ALIF patients reported superior 1-year PROMIS-PF, 6-week SF-12 PCS, 6-month VAS back, and 12-week VAS leg. No significant differences in MCID achievement rates were noted between cohorts. ALIF patients had higher RR in 6-week and 1-year PROMIS-PF and 6-week SF-12 PCS.
Conclusion
Workers’ compensation claimants undergoing either MIS-TLIF or ALIF reported significant improvement in pain and disability. ALIF patients reported superior postoperative physical function and pain. ALIF patients had higher recovery ratios in physical function. Workers’ compensation claimants undergoing ALIF may experience greater physical function recovery and superior clinical outcomes in physical function and pain.
To examine the use of local anesthesia and/or conscious sedation in endoscopic spine procedures within the past decade.
This systematic review abided by PRISMA guidelines. Embase, PubMed, Google ...Scholar, and Cochrane databases were searched for post-2011 articles with patients >18 years old, lumbar/cervical percutaneous endoscopic spine procedures using local/awake anesthesia, and patient/surgical outcomes. Reviews, book chapters, single case reports, or small case series (n ≤15 patients) were excluded. Scoring systems of the National Institutes of Health quality assessment tool, Newcastle-Ottawa Scale, and Cochrane Risk of Bias evaluated interventional case series, comparative studies, and randomized control trials, respectively.
Twenty-six articles were included, with 4 studies comparing general and local anesthesia. Of 2113 total patients, 1873 patients received local anesthesia. Significant improvements were seen in pain and disability scores. Studies that included MacNab scores showed that 96% of patients rated their postoperative satisfaction as excellent to good. Subanalysis of comparative studies showed a reduced risk of surgical/major medical complications and a slight increased risk for minor medical complications among awake spine patients. Length of stay was shorter for patients receiving local anesthesia.
The current systematic review and meta-analysis shows that use of local anesthesia is a safe and effective alternative to general anesthesia among different endoscopic spinal procedures. Although awake spine surgery is associated with a decreased risk of severe complications, lower revision rates, and higher postoperative satisfaction, more robust studies involving larger cohorts of patients are needed to evaluate the true impact of awake spine surgery on outcomes.
