Abstract
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.
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Data Availability
The data that support the findings of this study were generated at Rush University Medical Center and are available upon reasonable request from the corresponding author KS.
Abbreviations
- ALIF:
-
Anterior lumbar interbody fusion
- ASA:
-
American Society of Anesthesiologists
- BMI:
-
Body mass index
- CCI:
-
Charlson Comorbidity Index
- HNP:
-
Herniated nucleus pulposus
- IRB:
-
Institutional Review Board
- MCID:
-
Minimum clinically important difference
- MIS-TLIF:
-
Minimally invasive transforaminal lumbar interbody
- ODI:
-
Oswestry Disability Index
- PLIF:
-
Posterior lumbar interbody fusion
- POD:
-
Postoperative day
- PROMIS-PF:
-
Patient-Reported Outcomes Measurement Information System Physical Function
- PROs:
-
Patient-reported outcomes
- RR:
-
Recovery ratio
- SD:
-
Standard deviations
- SF-12 PCS:
-
12-Item Short Form Physical Component Score
- TLIF:
-
Transforaminal lumbar interbody fusion
- VAS:
-
Visual Analog Scale
- WC:
-
Workers’ compensation
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Contributions
James W. Nie: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, and writing—review and editing. Timothy J. Hartman: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, and writing—review and editing. Omolabake O. Oyetayo: project administration, data curation, investigation, and writing—review and editing. Keith R. MacGregor: project administration, data curation, investigation, and writing—review and editing. Eileen Zheng: project administration, data curation, investigation, and writing—review and editing. Dustin H. Massel: conceptualization, methodology, visualization, and writing—review and editing. Kern Singh: conceptualization, methodology, supervision, resources, investigation, and writing—review and editing.
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Ethical approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board (IRB) of Rush University Medical Center (ORA #14051301).
Consent to participate
Informed consent was obtained from all individual participants included in the study.
Conflict of interest
Kern Singh, MD receives royalties from Zimmer Biomet, Stryker, RTI Surgical, Lippincott Williams and Wilkins, Thieme, Jaypee Publishing, and Slack Publishing. Kern Singh, MD owns stock in Avaz Surgical LLC and Vital 5 LLC. Kern Singh, MD holds a consulting position with Zimmer Biomet and K2M. Kern Singh, MD holds board membership with Vital 5 LLC. Kern Singh, MD is on the editorial board of Contemporary Spine Surgery. Kern Singh, MD received a research grant from the Cervical Spine Research Society. Kern Singh, MD holds board membership with TDi LLC and Minimally Invasive Spine Study Group and receives no compensation as a board member. Kern Singh, MD is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as a member of the editorial board. Kern Singh, MD is on the board of directors of the Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as a member of the board of directors.
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Nie, J.W., Hartman, T.J., Oyetayo, O.O. et al. Recovery ratios and minimum clinically important difference for clinical outcomes in workers’ compensation recipients undergoing MIS-TLIF versus ALIF. Acta Neurochir 165, 315–323 (2023). https://doi.org/10.1007/s00701-022-05468-4
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DOI: https://doi.org/10.1007/s00701-022-05468-4