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Impact of preoperative symptom duration in patients undergoing lateral lumbar interbody fusion

  • Original Article - Spine - Other
  • Published:
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Abstract

Background

Few studies have examined the influence of preoperative symptom duration on clinical outcomes in patients undergoing lateral lumbar interbody fusion (LLIF) for degenerative conditions.

Methods

Patients undergoing LLIF presenting with radiculopathy and/or neurogenic claudication were separated into two groups: preoperative symptom duration < 1-year (shorter duration) versus duration ≥ 1-year (longer duration). Patients undergoing surgery for trauma/malignancy/infection were excluded. Patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), 12-Item Short Form Physical/Mental Component Score (SF-12 PCS/MCS), Patient Health Questionnaire-9 (PHQ-9), visual analog scale (VAS) back/leg, and Oswestry Disability Index (ODI) were collected at preoperative and postoperative time points.

Results

Eighty-two total patients, with 34 shorter-duration patients, were identified after propensity score matching for demographics. Longer-duration patients had higher estimated blood loss. All patients reported significant improvement in physical function, mental function, pain, and disability in at least one postoperative time point, except for SF-12 MCS in the shorter duration cohort. The longer duration cohort had higher MCID achievement in 12-week VAS back.

Conclusion

Patients undergoing LLIF demonstrated significant postoperative improvement in physical function, mental function, pain, and disability outcomes independent of preoperative symptom duration. Both cohorts, when compared by preoperative symptom duration, demonstrated similar postoperative PROM scores. Patients with longer preoperative symptom duration had higher 12-week leg pain MCID achievement. These findings suggest that delayed time to surgery may not lead to inferior clinical outcomes in patients undergoing LLIF for degenerative conditions.

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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

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CCI:

Charlson comorbidity index

EBL:

Estimated blood loss

HNP:

Herniated nucleus pulposus

LLIF:

Lateral lumbar interbody fusion

MCID:

Minimum clinically important difference

MIS-TLIF:

Minimally invasive transforaminal lumbar interbody fusion

PHQ-9:

Patient Health Questionnaire-9

PROMs:

Patient-reported outcome measures

POD:

Postoperative day

ODI:

Oswestry Disability Index

OME:

Oral morphine equivalents

PROMIS-PF:

Patient-reported outcome measurement information system-physical function

SF-12 MCS:

12-Item Short Form Mental Component Score

SF-12 PCS:

12-Item Short Form Physical Component Score

SPORT:

Spine Patient Outcomes Research Trial

VAS:

Visual analog scale

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL, 60612, USA

    James W. Nie, Timothy J. Hartman, Omolabake O. Oyetayo, Keith R. MacGregor, Eileen Zheng, Alexander W. Parsons, Dustin H. Massel, Arash J. Sarari & Kern Singh

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  1. James W. Nie
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  2. Timothy J. Hartman
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  3. Omolabake O. Oyetayo
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  4. Keith R. MacGregor
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  5. Eileen Zheng
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  6. Alexander W. Parsons
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  7. Dustin H. Massel
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  8. Arash J. Sarari
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  9. Kern Singh
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Contributions

James W. Nie, BS: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, writing—review and editing. Timothy J. Hartman, MD: conceptualization, methodology, visualization, formal analysis, software, investigation, writing—original draft, writing—review and editing. Omolabake O. Oyetayo, BS: project administration, data curation, investigation, writing—review and editing. Keith R. MacGregor, BS: project administration, data curation, investigation, writing—review and editing. Eileen Zheng, BS: project administration, data curation, investigation, writing—review and editing. Alexander W. Parsons, BS: project administration, data curation, investigation, writing—review and editing. Arash J. Sayari, MD: conceptualization, methodology, supervision, resources, investigation, writing—review and editing. Dustin H. Massel, MD: conceptualization, methodology, supervision, resources, investigation, writing—review and editing. Kern Singh, MD: conceptualization, methodology, supervision, resources, investigation, writing—review and editing.

Corresponding author

Correspondence to Kern Singh.

Ethics declarations

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).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Competing interests

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 board member. Kern Singh, MD is on the editorial board of Orthopedics Today and Vertebral Columns and receives no compensation as member of the editorial board. Kern Singh, MD is on the board of directors of Cervical Spine Research Society, International Society for the Advancements of Spine Surgery, and American Academy of Orthopaedic Surgeons and receives no compensation as member of the board of directors.

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Nie, J.W., Hartman, T.J., Oyetayo, O.O. et al. Impact of preoperative symptom duration in patients undergoing lateral lumbar interbody fusion. Acta Neurochir 165, 89–97 (2023). https://doi.org/10.1007/s00701-022-05436-y

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