Background context:

Surgical counseling enables shared decision-making (SDM) by improving patients’ understanding.

Purpose:

To provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery.

Study design:

Retrospective review of prospectively collected data PATIENT SAMPLE: Patients who underwent primary tubular minimally invasive lumbar spine surgery in form of transforaminal lumbar interbody fusion (MI-TLIF), decompression alone, or microdiscectomy and had a minimum of 1-year follow-up.

Outcome measures:

1. Surgical (radiation exposure and intraoperative complications) 2.Immediate postoperative (length of stay [LOS] and complications) 3. Clinical outcomes (Visual Analog Scale- back and leg, VAS; Oswestry Disability Index, ODI; 12-Item Short Form Survey Physical Component Score, SF-12 PCS; Patient-Reported Outcomes Measurement Information System Physical Function, PROMIS PF; Global Rating Change, GRC; return to activities; complications/reoperations) METHODS: The outcome measures were analyzed to provide answers to ten FAQs that were compiled based on the authors’ experience and a review of literature.Changes in VAS back, VAS leg, ODI, and SF-12 PCS from preoperative values to the early (<6 months) and late (>6months) postoperative timepoints were analyzed with Wilcoxon Signed Rank Tests. % of patients achieving minimal clinically important difference (MCID) for these patient-reported outcome measures (PROMs) at the two timepoints was evaluated. Changes in PROs from preoperative values to early (<6 months) and late (≥6 months) postoperative timepoints were analyzed within each of the three groups. % of patients achieving MCID was also evaluated.

Results:

366 patients (104 TLIF, 147 decompression, 115 microdiscectomy) were included. The following FAQs were answered: 1. Will my back pain improve? Most patients report improvement by >50%. About 60% of TLIF, decompression, and microdiscectomy patients achieved MCID at ≥6 months. 2. Will my leg pain improve? Most patients report improvement by >50%. 56% of TLIF, 67% of decompression, and 70% of microdiscectomy patients achieved MCID at ≥6 months. 3. Will my activity level improve? Most patients report significant improvement. 66% of TLIF, 55% of decompression, and 75% of microdiscectomy patients achieved MCID for SF-12 PCS. 4. Is there a chance I will get worse? 6% after TLIF, 14% after decompression, and 5% after microdiscectomy. 5. Will I receive a significant amount of radiation? The radiation exposure is likely to be acceptable and nearly insignificant in terms of radiation-related risks. 6. What is the likelihood that I will have a complication? 17.3% (15.4% minor, 1.9% major) for TLIF, 10% (9.3% minor and 0.7% major) for decompression, and 1.7% (all minor) for microdiscectomy 7. Will I need another surgery? 6% after TLIF, 16.3% after decompression, 13% after microdiscectomy. 8. How long will I stay in the hospital? Most patients get discharged on postoperative day one after TLIF and on the same day after decompression and microdiscectomy. 9. When will I be able to return to work? >80% of patients return to work (average: 25 days after TLIF, 14 days after decompression, 11 days after microdiscectomy). 10. Will I be able to drive again? >90% of patients return to driving (average: 22 days after TLIF, 11 days after decompression, 14 days after microdiscectomy).

Conclusions:

These concise answers to the FAQs in minimally invasive lumbar spine surgery can be used by physicians as a reference to enable patient education.