scholarly journals Are Patient-Reported Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion Influenced by Preoperative Mental Health?

2020 ◽  
pp. 219256822091271 ◽  
Author(s):  
Graham S. Goh ◽  
Ming Han Lincoln Liow ◽  
Wai-Mun Yue ◽  
Seang-Beng Tan ◽  
John Li-Tat Chen
Keyword(s):  
Mental Health ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Patient Reported Outcome Measures ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Sf 36 ◽  
Patient Reported

Study design: This was a retrospective review of prospectively collected data. Objectives: Few studies have described the relationship between mental health and patient-reported outcome measures (PROMs) after minimally invasive spine surgery. Prior studies on open surgery included small cohorts with short follow-ups. Methods: Patients undergoing primary minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative pathology were retrospectively reviewed and stratified by Short Form (SF-36) Mental Component Summary (MCS): low MCS (<50, n = 436) versus high MCS (≥50, n = 363). PROMs assessed were back pain, leg pain, North American Spine Society Neurogenic Symptoms, Oswestry Disability Index, SF-36 Physical Component Summary, and MCS. Satisfaction, expectation fulfilment, and return to work (RTW) rates also were recorded at 1 month, 3 months, 6 months, and 2 years. Results: Preoperative MCS was 39.4 ± 8.6 and 58.5 ± 5.4 in the low and high MCS groups, respectively ( P < .001). The low MCS group had significantly poorer preoperative PROMs and longer lengths of stay. Despite this, both groups achieved comparable PROMs from 3 months onward. The mean MCS was no longer significantly different by 3 months ( P = .353). The low MCS group had poorer satisfaction ( P = .022) and expectation fulfilment ( P = .020) at final follow-up. RTW rates were initially lower in the low MCS group up to 3 months ( P = .034), but the rates converged from 6 months onward. Conclusions: Despite poorer PROMs preoperatively, patients with poor baseline mental health still achieved comparable results from 3 months up to 2 years after MIS-TLIF. Preoperative optimization of mental health should still be pursued to improve satisfaction and prevent delayed RTW after surgery.

scholarly journals Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Provides Sustained Improvements in Clinical and Radiological Outcomes up to 5 Years Postoperatively in Patients with Neurogenic Symptoms Secondary to Spondylolisthesis

2017 ◽  
Vol 11 (2) ◽  
pp. 204-212 ◽  
Author(s):  
Hamid Rahmatullah Bin Abd Razak ◽  
Priyesh Dhoke ◽  
Kae-Sian Tay ◽  
William Yeo ◽  
Wai-Mun Yue
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Single Level ◽  
Sf 36 ◽  
Cage Subsidence ◽  
The Mean

<sec><title>Study Design</title><p>Retrospective review of prospective registry data.</p></sec><sec><title>Purpose</title><p>To determine 5-year clinical and radiological outcomes of single-level instrumented minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients with neurogenic symptoms secondary to spondylolisthesis.</p></sec><sec><title>Overview of Literature</title><p>MIS-TLIF and open approaches have been shown to yield comparable outcomes. This is the first study to assess MIS-TLIF outcomes using the minimal clinically important difference (MCID) criterion.</p></sec><sec><title>Methods</title><p>The outcomes of 56 patients treated by a single surgeon, including the Oswestry disability index (ODI), neurogenic symptom score, short-form 36 questionnaire (SF-36), and visual analog scale (VAS) scores for back pain (BP), and leg pain (LP), were collected prospectively for up to 5 years postoperatively. Radiological outcomes included adjacent segment degeneration, fusion, cage subsidence, and screw loosening rates.</p></sec><sec><title>Results</title><p>Our patients were predominantly female (71.4%) and had a mean age of 53.7±11.3 years and mean body mass index of 25.7±3.7 kg/m<sup>2</sup>. The mean operative time, blood loss, time to ambulation, and hospitalization were 167±49 minutes, 126±107 mL, 1.2±0.4 days, and 2.8±1.1 days, respectively. The mean fluoroscopic time was 58.4±33 seconds, and the mean postoperative intravenous morphine dose was 8±2 mg. Regarding outcomes, postoperative scores improved relative to preoperative scores, and this was sustained across various time points for up to 5 years (<italic>p</italic>&lt;0.001). Improvements in ODI, SF-36, VAS-BP, and VAS-LP all met the MCID criterion. Notably, 5.4% of our patients developed clinically significant adjacent segment disease during follow-up, and 7 minor complications were reported.</p></sec><sec><title>Conclusions</title><p>Single-level instrumented MIS-TLIF is suitable for patients with neurogenic symptoms secondary to lumbar spondylolisthesis and is associated with an acceptable complication rate. Both clinical and radiological outcomes were sustained up to 5 years postoperatively, with many patients achieving an MCID.</p></sec>

Validity of PROMIS in minimally invasive transforaminal lumbar interbody fusion: a preliminary evaluation

2018 ◽  
Vol 29 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Jordan A. Guntin ◽  
Kaitlyn L. Cardinal ◽  
Daniel D. Bohl ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Preliminary Evaluation ◽  
Lumbar Interbody Fusion ◽  
Strong Correlations ◽  
Patient Reported

OBJECTIVEPatient-reported outcomes are commonly used to evaluate treatment efficacy. Inefficiencies in standard measurement tools often prove to be a barrier to data collection. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to overcome these limitations. This tool implements computer-adaptive testing, which enables the assessment of physical function in fewer questions than those required for “static” metrics. In spine surgery patients, moderate to strong correlations with Oswestry Disability Index (ODI) and the 36-Item Short Form Survey (SF-36) scores have been reported for PROMIS. However, to date, data regarding the efficacy of this tool for patients undergoing minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) have been limited.METHODSA prospectively maintained registry of patients who have undergone primary 1- or 2-level MIS TLIF was reviewed retrospectively. Patients with incomplete PROMIS data were excluded. Changes in PROMIS physical function scores 6 weeks, 12 weeks, and 6 months after surgery were analyzed using paired t-tests. PROMIS scores were compared with traditional outcome measures, including SF-12 physical function, ODI, and visual analog scale (VAS) back and leg scores. Correlations were tested using the Pearson correlation coefficient, and the strength of association was interpreted as follows: small, 0.1 ≤ |r| < 0.3; moderate, 0.3 ≤ |r| < 0.5; and large, |r| ≥ 0.5. Statistical significance was set at p < 0.05.RESULTSSeventy-four patients were included in this analysis after the exclusion of those without PROMIS scores. The mean preoperative PROMIS score was 35.92 ± 6.98. Significant improvements were demonstrated in PROMIS scores 12 weeks (41.33, p < 0.001) and 6 months (43.58, p < 0.001) after surgery. PROMIS scores demonstrated a significant correlation with SF-12, ODI, and VAS leg scores (p < 0.05). Strong associations with PROMIS scores were observed for SF-12 (r = 0.650 to 0.854), ODI (r = −0.525 to −0.831), and 6-month VAS back (r = −0.693) scores.CONCLUSIONSPhysical function as measured by PROMIS improves significantly 12 weeks and 6 months after MIS TLIF. In addition, PROMIS scores have strong correlations with SF-12 and ODI scores. These results suggest that PROMIS scores can be used as a valid assessment of physical function in MIS TLIF patients. Further work is required to determine the full benefits of this measure in other spine populations.

Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study

2013 ◽  
Vol 35 (2) ◽  
pp. E13 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Alexander T. Nixon ◽  
Cort D. Lawton ◽  
Albert P. Wong ◽  
Zachary A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Lost To Follow Up

Object Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is used to treat a wide variety of lumbar degenerative disorders. Although there are some reports showing efficacy of unilateral instrumentation during MIS-TLIF, a controlled randomized prospective study has not been done. Methods Forty-one patients were randomly assigned to receive either bilateral or unilateral instrumentation following 1-level unilateral MIS-TLIF. Four patients were lost to follow-up in the unilateral group and 1 patient was lost to follow-up in the bilateral group. Preoperative and postoperative scores on a visual analog scale (VAS) for back pain and leg pain (VAS-BP and VAS-LP, respectively), Oswestry Disability Index (ODI), and 36-Item Short Form Healthy Survey version 2 (SF-36v2) were collected. Additionally, preoperative and postoperative segmental Cobb angles and radiographic evidence of fusion were analyzed. Results There was no statistically significant difference in baseline demographic characteristics between the 2 groups. The VAS-BP, VAS-LP, ODI, and SF-36v2 physical component scores improved significantly after surgery in both groups (p < 0.05); there was no statistically significant between-groups difference in the degree of improvement. Blood loss was significantly higher in the bilateral instrumentation group and hospital stay was longer in the unilateral instrumentation group. There was no statistically significant between-groups difference with respect to change in segmental lordosis or fusion rate. The average duration of follow-up was 12.4 months for the bilateral instrumentation group and 11.4 months for the unilateral instrumentation group. Conclusions Clinical and radiographic outcomes of unilateral and bilateral instrumentation for unilateral MISTLIF are similar 1 year after surgery.

scholarly journals Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial

2019 ◽  
Vol 30 (2) ◽  
pp. 222-227 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Dil V. Patel ◽  
Mundeep S. Bawa ◽  
Junyoung Ahn ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Perioperative Outcomes ◽  
Inpatient Stay ◽  
Lumbar Interbody Fusion ◽  
Acute Postoperative Pain ◽  
Estimated Blood Loss ◽  
Patient Reported

OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospective, randomized, single-blinded study was performed. A priori power analysis determined that 86 patients were needed to detect a difference of 1 point in the visual analog scale (VAS) pain score between groups. Ninety-three patients were randomized into depomedrol (DEPO) and no depomedrol (NODEPO) cohorts. Prior to surgical closure, DEPO patients received 1 ml depomedrol (80 mg) applied directly to the surgical site by using a Gelfoam carrier. NODEPO patients received 1 ml saline on the same Gelfoam carrier. Perioperative outcomes including acute postoperative pain and narcotic use were assessed for the duration of inpatient stay. Patient-reported outcomes (PROs) questionnaires including VAS back and leg pain scores, and Oswestry Disability Index (ODI) were administered preoperatively and at 6-week, 12-week, and 6-month follow-up. Outcomes for DEPO and NODEPO cohorts were compared using linear regression controlled for sex.RESULTSOf the 93 patients, 45 (48.4%) were randomized to DEPO and 48 (51.6%) to NODEPO. A greater percentage of DEPO patients were female (53.3% vs 27.1%, p = 0.010). There were no other significant differences in patient baseline characteristics. Similarly, operating time, estimated blood loss, and length of inpatient stay did not differ between cohorts. Patients in the DEPO cohort consumed fewer hourly narcotics on postoperative day 0 (5.3 vs 6.3 oral morphine equivalents/hour, p = 0.034). However, no differences in acute postoperative pain or total narcotics consumption were observed between groups. Preoperative VAS leg scores were statistically different between cohorts (p = 0.027). However, preoperative ODI and VAS back scores did not differ between groups. Additionally, DEPO and NODEPO groups experienced similar improvements in PROs at all postoperative time points.CONCLUSIONSLocal depomedrol use did not lead to decreases in acute postoperative pain or narcotics consumption after MIS TLIF. Additionally, local depomedrol was not associated with postoperative improvements in PROs. The findings of this randomized trial suggest that surgical and clinical outcomes following MIS TLIF may not be impacted by intraoperative application of depomedrol.Clinical trial registration no.: NCT03308084 (clinicaltrials.gov)

scholarly journals A Comparison of Minimally Invasive Transforaminal Lumbar Interbody Fusion and Decompression Alone for Degenerative Lumbar Spondylolisthesis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Andrew Kai-Hong Chan ◽  
Erica F Bisson ◽  
Mohamad Bydon ◽  
Steven D Glassman ◽  
Kevin T Foley ◽  
...  
Keyword(s):  
Back Pain ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Reoperation Rate ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Lumbar Spondylolisthesis

Abstract INTRODUCTION The optimal minimally invasive surgical (MIS) approach for lumbar spondylolisthesis is not clearly elucidated. This study compares patient reported outcomes (PRO) following MIS transforaminal lumbar interbody fusion (MI-TLIF) and MIS decompression for degenerative lumbar spondylolisthesis. METHODS A total of 608 patients from the Quality Outcomes Database (QOD) Lumbar Spondylolisthesis Module underwent single-level surgery for degenerative grade 1 lumbar spondylolisthesis of whom 143 underwent MIS [72 MI-TLIF (50.3%) and 71 MIS decompressions (49.7%)]. Surgeries were classified as MIS if there was utilization of percutaneous screw fixation and placement of a Wiltse-plane MIS intervertebral body graft (MI-TLIF) or if there was a tubular decompression (MIS decompression). In total, 24-mo follow-up parameters were collected. PROs included the Oswestry Disability Index (ODI), numeric rating scale (NRS) Back Pain, NRS Leg Pain, EuroQoL-5D (EQ-5D) Questionnaire, and North American Spine Society (NASS) Satisfaction Questionnaire. Multivariate models were constructed adjusting for baseline patient and surgical factors. RESULTS The mean age of the MIS cohort was 67.1 ± 11.3 yr (MI-TLIF 62.1 yr vs MIS decompression 72.3 yr) and consisted of 79 (55.2%) women (MI-TLIF 55.6% vs MIS decompression 54.9%). The proportions reaching 24-mo follow-up were similar (MI-TLIF 83.3% and MIS decompression 84.5%; P = .85). MI-TLIF was associated with higher blood loss (108.8 vs 33.0 mL, P < .001), longer operative times (228.2 vs 101.8 min, P < .001) and length of hospitalization (2.9 vs 0.7 d, P < .001). MI-TLIF was associated with a significantly lower reoperation rate (14.1% vs 1.4%, P = .004). Both cohorts demonstrated significant improvements in ODI, NRS back pain, NRS leg pain, and EQ-5D at 24 mo (P < .001). In multivariate analyses, MI-TLIF was associated with superior ODI change (ß = −7.59; 95% CI [−14.96 to −0.23]; P = .04), NRS back pain change (ß = −1.54; 95% CI [−2.78 to −0.30]; P = .02), and NASS satisfaction (OR = 0.32; 95% CI [0.12-0.82]; P = .02). CONCLUSION For symptomatic, single-level degenerative spondylolisthesis, MI-TLIF was associated with a 10-fold lower reoperation rate and superior outcomes for disability, back pain, and patient satisfaction compared to MIS decompression alone.

scholarly journals Percutaneous Endoscopic Lumbar Interbody Fusion: Technical Note and Preliminary Clinical Experience with 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Junlong Wu ◽  
Huan Liu ◽  
Shengxiang Ao ◽  
Wenjie Zheng ◽  
Changqing Li ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Interbody Fusion ◽  
Short Form ◽  
Minimal Invasive ◽  
Leg Pain ◽  
Large Sample Size ◽  
Lumbar Interbody Fusion ◽  
Improvement Rate ◽  
Sf 36

Objective. Endoscopic surgeries have been attempted in the field of lumbar decompression and fusion surgery in the past decade. Percutaneous endoscopic lumbar interbody fusion (PELIF) is a new-emerging technique taking advantages of an anatomical (Kambin’s triangle) to achieve simultaneous decompression and fusion under endoscopic visualization. The purpose of this study is to evaluate the feasibility and safety of PELIF technique with general anesthesia and neuromonitoring.Methods. The authors present the details of PELIF technique with general anesthesia and neuromonitoring. The first 7 consecutive patients treated with minimum of 2 year’s follow-up were included. Clinical outcomes were assessed by visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI) scores, and the Short Form-36 health survey questionnaire (SF-36) in the immediate preoperative period and during the follow-up period.Results. All patients underwent single-level PELIF surgery successfully and without conversion to open surgery. The average age was 56.0±13.0 years. All patients had Grade I degenerative/isthmic spondylolisthesis and 4 patients coexisted with disc herniation. The mean operative time was 167.5±30.9 minutes, and intraoperative blood loss was 70.0±24.5 ml. Postoperative drainage volume was 24.5±18.3 ml. The differences in the VAS scores for low back pain and leg pain between preoperative and follow-up were significant (P<0.05). The SF-36 Physical Component Summary (PCS) improved from 38.83±4.17 to 55.67±2.58 (P<0.001). The SF-36 Mental Component Summary (MCS) improved from 43.83±3.13 to 57.50±5.36 (P=0.001). The ODI score improvement rate was 33.7±3.7 %. All cases demonstrated radiopaque graft in the intervertebral disc space consistent with solid arthrodesis.Conclusions. PELIF technique seems to be a promising surgical technique for selected appropriate patients, with the minimal invasive advantages in decreased blood, shortage of ambulation time, and hospital stay, compared with MIS-TLIF. Because of limited Kambin’s triangle space and the exiting nerve root nearby, PELIF is still a challenging technique. Future advancement and development in instrument and cage design are vital for application and popularization of this technique. Prospective, randomized, controlled studies with large sample size on PELIF technique are still needed to prove its safety, efficacy, and minimal invasive advantages.

scholarly journals Improvements in Back and Leg Pain Following a Minimally Invasive Transforaminal Lumbar Interbody Fusion

10.14444/7107 ◽  
2020 ◽  
Vol 14 (5) ◽  
pp. 745-755
Author(s):  
DUSTIN H. MASSEL ◽  
BENJAMIN C. MAYO ◽  
ANKUR S. NARAIN ◽  
FADY Y. HIJJI ◽  
PHILIP K. LOUIE ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion
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