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Effect of baseline veterans RAND-12 physical composite score on postoperative patient-reported outcome measures following lateral lumbar interbody fusion

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Abstract

Purpose

To determine the prognostic value of preoperative Veterans RAND-12 (VR-12) Physical Composite Score (PCS) scores on postoperative clinical outcomes in patients undergoing lateral lumbar interbody fusion (LLIF).

Methods

LLIF patients were separated into 2 cohorts based on preoperative VR-12 PCS scores: VR-12 PCS < 30 (lesser physical function) and VR-12 PCS ≥ 30 (greater physical function). Patient-reported outcome measures (PROMs) of VR-12 PCS, VR-12 Mental Composite Score (MCS), Short Form-12 (SF-12) PCS, SF-12 MCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back Pain (VAS-BP), VAS Leg Pain (VAS-LP), and Oswestry Disability Index (ODI) were collected at preoperative and up to 2-year postoperative time points. Mean postoperative follow-up time was 16.69 ± 8.53 months. Minimum clinically important difference (MCID) achievement was determined by comparing ∆PROM to previously established thresholds.

Results

Seventy-eight patients were included, with 38 patients with lesser preoperative physical function scores. Patients with lesser physical function reported significantly inferior preoperative PROM scores in all domains, except for SF-12 MCS and VAS-LP. At the 6-week postoperative time point, patients with lesser physical function reported significantly inferior VR-12 PCS, VR-12 MCS, SF-12 PCS, PROMIS-PF, and PHQ-9. At the final postoperative time point, patients with lesser physical function reported significantly inferior VR-12 PCS, VR-12 MCS, PROMIS-PF, PHQ-9, and ODI. Magnitude of 6-week postoperative improvement was significantly higher in the lesser physical function cohort for VR-12 PCS.

Conclusion

Patients undergoing LLIF with worse baseline VR-12 PCS scores reported inferior postoperative physical function, mental health, and disability outcomes. At the final postoperative follow-up, magnitude of postoperative improvement and MCID achievement did not significantly differ. Baseline VR-12 PCS scores may indicate inferior postoperative clinical outcomes in physical function, mental health, and disability in patients undergoing LLIF; however, baseline VR-12 PCS does not limit the magnitude of postoperative improvement.

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Data availability

The findings presented in this study are available upon request from the corresponding principle investigator, Kern Singh at kern.singh@rushortho.com.

Abbreviations

ASA :

American Society of Anesthesiologists

BMI :

Body mass index

CCI :

Charlson Comorbidity Index

LLIF :

Lateral lumbar interbody fusion

MCID :

Minimum clinically important difference

MCS :

Mental Component Score

MIS :

Minimally invasive surgery

ODI :

Oswestry Disability Index

OME :

Oral morphine equivalents

ORA :

Office of Regulatory Affairs

PCS :

Physical Component Score

PHQ-9 :

Patient Health Questionnaire-9

POD :

Postoperative day

PROMIS-PF :

Patient-Reported Outcomes Measurement Information System Physical Function

PROMs :

Patient-reported Outcome Measures

SF-12 :

12-Item Short Form

TLIF :

Transforaminal lumbar interbody fusion

VAS :

Visual Analog Scale

VAS-BP :

Visual Analog Scale Back Pain

VAS-LP :

Visual Analog Scale Leg Pain

VR-12 :

Veterans RAND-12

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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

    Omolabake O. Oyetayo, James W. Nie, Timothy J. Hartman, Keith R. MacGregor, Eileen Zheng, Fatima N. Anwar, Andrea M. Roca, Vincent P. Federico, Dustin H. Massel, Gregory D. Lopez, Arash J. Sayari & Kern Singh

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  1. Omolabake O. Oyetayo
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  2. James W. Nie
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Contributions

Omolabake O. Oyetayo, BS: Conceptualization, Methodology, Visualization, Formal Analysis, Software, Investigation, Writing – Original Draft, Writing – Review & Editing

James W. Nie, BS: Conceptualization, Methodology, Visualization, Formal Analysis, Software, Investigation, Writing – Original Draft, Writing – Review & Editing

Timothy J. Hartman, MD: Conceptualization, Methodology, Visualization, Formal Analysis, Software, Investigation, Writing – Review & Editing

Keith R. MacGregor, BS: Project Administration, Data Curation, Investigation, Writing – Review & Editing

Eileen Zheng, BS: Project Administration, Data Curation, Investigation, Writing – Review & Editing

Fatima N. Anwar, BA: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & Editing

Andrea M. Roca, MA: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & Editing

Vincent P. Federico, MD: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & Editing

Dustin H. Massel, MD: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & Editing

Arash J. Sayari, MD: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & Editing

Gregory D. Lopez, MD: Conceptualization, Methodology, Supervision, Resources, Writing – Review & Editing

Kern Singh, MD: Conceptualization, Methodology, Supervision, Resources, Investigation, Writing – Review & 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).

Financial 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.

Non-financial interests

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.

Informed consent

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

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Oyetayo, O.O., Nie, J.W., Hartman, T.J. et al. Effect of baseline veterans RAND-12 physical composite score on postoperative patient-reported outcome measures following lateral lumbar interbody fusion. Acta Neurochir 165, 3531–3537 (2023). https://doi.org/10.1007/s00701-023-05763-8

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