Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis

Hijji, Fady Y.; Narain, Ankur S.; Bohl, Daniel D.; Yom, Kelly H.; Kudaravalli, Krishna T.; Lopez, Gregory D.; Singh, Kern

doi:10.1097/bsd.0000000000000543

Cited by 25 publications

(10 citation statements)

References 44 publications

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“…More specifically, being listed as having workers' compensation was associated with an increased risk for MCID failure, which may be attributed to more severe nonage-related spinal pathology of the intervertebral disc space in this population. Previous MCID studies reported that worker's compensation was a risk factor for outcomes in transforaminal lumbar fusion patients 6 and was similarly identified in a systematic review, which established the association between compensation status and poorer postoperative outcomes. 28,29 Other studies also implicate insurance collected as a prognostic factor, as achievement of MCID and sustained improvement of lower back pain following decompression surgery was reportedly associated with lack of compensation claims and absence of narcotic usage.…”

Section: Discussionmentioning

confidence: 86%

“…5 Additionally, Hijji et al reported worker's compensation status to be negatively associated with MCID achievement for VAS back pain in those undergoing minimally invasive transforaminal lumbar interbody fusion (TLIF). 6 While both of these studies make important contributions to understanding MCID achievement in the spine population, their focus on anterior cervical discectomy and fusion and TLIF limits their applicability to risk factors associated with fusion procedures only.…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression

et al. 2022

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Background: Clinically important postoperative changes can be best evaluated through the minimal clinically important difference (MCID). Our study aims to evaluate risk factors associated with failure to achieve MCID following lumbar decompression (LD).Methods: Demographics, perioperative characteristics, and patient-reported outcome measures (PROM) for pain, disability, and physical function were retrospectively reviewed and collected for patients undergoing LD. MCID achievement was calculated using established values. Relative risk of demographic and perioperative characteristics with failure to meet MCID for all PROMs was calculated. Least absolute shrinkage and selection operator (LASSO) was used to estimate individual risk factors, and postestimation logistic regression was performed.Results: The study cohort included 811 patients. Comorbidity burden was associated with failed MCID for visual analog scale (VAS) back and leg pain and Oswestry Disability Index (ODI). Operative levels or duration was associated with failed MCID for VAS leg pain, 12-item short form physical component summary (SF-12 PCS), and the patient-reported outcomes measurement information system physical function (PROMIS PF). Preoperative spinal pathology was associated with failed MCID for VAS leg pain, ODI, SF-12 PCS, and PROMIS PF. Additional risk factors included the type of operation, insurance, age, and body mass index. LASSO selected insurance, age, comorbidity burden, blood loss, operative duration, and type of spinal pathology as significant risk factors for failure to reach MCID.Conclusion: Failure to reach MCID was greatest for VAS back. Age, comorbidity burden, and prolonged procedures were significantly associated with risk for failure to reach MCID for a majority of PROMs. Comorbidity burden combined with operative outcomes may place patients at increased risk for failure to reach MCID for pain, disability, and physical function following LD.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression

et al. 2022

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“…Regarding MCID attainment for ODI, Hijji et al [ 28 ] found no significant difference between WC and non-WC individuals following MIS TLIF. Mayo et al [ 26 ] also found no significant difference in the ODI MCID achievement rates when stratifying lumbar fusion recipients into MCS groups.…”

Section: Discussionmentioning

confidence: 99%

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

et al. 2023

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This study investigated the influence of preoperative mental health on patient-reported outcome measures (PROMs) and minimal clinically important difference (MCID) among workers' compensation (WC) recipients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Overview of Literature: No studies have evaluated the impact of preoperative mental functioning on outcomes following MIS TLIF among WC claimants. Methods: WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology. Results:The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004). Conclusions: Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1-2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health.

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“…16,17 Our study is aligned with previous studies that have observed spine surgery patients with a higher comorbidity burden to be older, to smoke, and to have been diagnosed with diabetes, arthritis, hypertension, or a malignancy. 6,18,[24][25][26] As these previous studies have highlighted, to improve clinical outcomes, it is imperative to evaluate patients with comorbidities. While other studies have more narrowly focused on specific PROMs or complications after lumbar surgery, 27 there is a scarcity of research focused on the influence of increased comorbidity burden on achieving a well-known metric such as MCID among multiple PROMs.…”

Section: Discussionmentioning

confidence: 99%

“…No patients had arthritis within the no comorbidity subgroup (CCI ¼ 0), 17.8% (13) had arthritis in the moderate comorbidity subgroup (CCI ¼ 1-2), and 36.2% (17) had arthritis in the most severely comorbid group burden (P , 0.001). Among the subgroups, the fraction of those with hypertension increased with CCI severity (CCI ¼ 0: 0.0% [0]; CCI ¼ 1-2: 27.4% [20]; CCI 3: 55.3% [26], P , 0.001). Neither of the lesser comorbidity burden subgroups had any patients with malignancies, though the most severe comorbidity burden subgroup had 31.9% (15) with a past malignancy (P , 0.001).…”

Section: Baseline Demographic and Perioperative Characteristicsmentioning

confidence: 99%

Charlson Comorbidity Index: An Inaccurate Predictor of Minimally Invasive Lumbar Spinal Fusion Outcomes

et al. 2021

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Background: There is a scarcity of research on the Charlson Comorbidity Index (CCI) and its influence on minimum clinically important difference (MCID) achievement after minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). The objective of this study is to detail the association between the CCI and attaining MCID after MIS TLIF.Methods: A prospective surgical registry was retrospectively reviewed for spine surgeries between May 2015 and February 2019. Inclusion criteria were primary or revision, 1-or 2-level MIS TLIF procedures. Patients were stratified based on CCI score: 0 points (no comorbidities), 1-2 points (mild CCI), 3 points (moderate CCI). Preoperative, intraoperative, and postoperative variables were assessed by subgroup using appropriate statistical analysis. Subgroups were analyzed with linear regression or v 2 tests for continuous or categorical variables, respectively. Subgroup scores, improvement, and MCID achievement were assessed at postoperative timepoints (eg, 6 weeks, 12 weeks, 6 months, and 1 year) for back and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Composite Score (PCS), and Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS PF).Results: A total of 171 patients were included (n ¼ 51 [no comorbidities], n ¼ 73 [mild CCI], and n ¼ 47 [moderate CCI]). Higher CCI patients were older and more likely to be smokers, diabetic, arthritic, hypertensive, or have a malignancy history (P , 0.003). Preoperatively, ODI and PROMIS PF were the only patient-reported outcomes with a significant association by CCI group (P ¼ 0.015 and 0.014). Back pain was the only measure that had a significant association with the CCI subgroup at 1 year for score (P ¼ 0.002) or MCID (P ¼ 0.028).Conclusions: By 1 year, regardless of the number of comorbidities, a similar proportion of patients undergoing MIS TLIF were able to achieve MCID for visual analog scale leg, SF-12 PCS, and PROMIS PF. Patients with higher comorbidities are not likely to experience a significant difference in symptom improvement. Regardless of CCI score, MIS TLIF can have a significant benefit for patients.Level of Evidence: IV.

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Risk Factors Associated With Failure to Reach Minimal Clinically Important Difference in Patient-reported Outcomes Following Minimally Invasive Transforaminal Lumbar Interbody Fusion for Spondylolisthesis

Abstract: The results of this study suggest that a majority of patients with spondylolisthesis achieve MCID for commonly measured PROs following MIS TLIF for spondylolisthesis. However, worker's compensation insurance status may serve as a negative predictive factor for reaching MCID.

Cited by 25 publications

References 44 publications

Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression

Risk Factors for Failing to Reach a Minimal Clinically Important Difference Following Minimally Invasive Lumbar Decompression

Does Baseline Mental Health Influence Outcomes among Workers’ Compensation Claimants Undergoing Minimally Invasive Transforaminal Lumbar Interbody Fusion?

Charlson Comorbidity Index: An Inaccurate Predictor of Minimally Invasive Lumbar Spinal Fusion Outcomes

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