Objective:

Compare patient-reported outcome measures (PROMs), satisfaction, and minimum clinically important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in patients stratified by preoperative leg pain.

Methods:

Patients undergoing MIS-TLIF were collected through retrospective review of a prospectively maintained single-surgeon database. PROMs administered pre/post-operatively included Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Visual Analog Scale (VAS) back/leg pain, Oswestry Disability Index (ODI), and 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS). Patients were grouped based on preoperative VAS leg scores: VAS leg≤7 or VAS leg>7. Inferential statistics were utilized to compare PROMs, MCID achievement rates, and postoperative satisfaction between groups.

Results:

562 patients were eligible (168 VAS leg≤7; 394 VAS leg>7). Significant differences between cohorts in postoperative mean PROMs were noted for: PROMIS-PF 6-weeks/2-years, SF-12 PCS 6-weeks/2-year, SF-12 MCS 6-week/12-weeks/6-months/1-year, VAS back 6-weeks/12-weeks/6-months, VAS leg 6-weeks/12-weeks/6-months/2-years and ODI at all postoperative timepoints (p<0.045, all). VAS leg>7 cohort demonstrated greater proportion achieving MCID for VAS leg at all postoperative timepoints and ODI at 12-weeks (p<0.010, all). Postoperative satisfaction was greater in VAS back≤7 cohort for: VAS leg 6-weeks/12-weeks/6-months/2-years, VAS back 12-weeks/2-years, and ODI 6-weeks/12-weeks/6-months/2-years (p<0.046, all).

Conclusion:

Patients with severe preoperative leg pain demonstrated worse postoperative PROM scores and patient satisfaction for disability and back/leg pain. MCID achievement rates across cohorts were similar. Patients with severe leg pain may have expectations for surgical benefits incongruent with their postoperative outcomes, and physicians may seek to manage the preoperative expectations of their patients to reflect likely outcomes following MIS-TLIF.