Objective:

To conduct a preliminary analysis on the impact of time to surgery (TTS) and duration of symptoms (DOS) on clinical outcomes in workers’ compensation patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Methods:

WC patients undergoing primary, single-level MIS TLIF were identified. PROMs were administered at preoperative/6-week/12-week/6-month postoperative timepoints and included VAS back/VAS leg/ODI/SF-12 PCS/SF-12 MCS. Patients were grouped by TTS: <90 days, 90-179 days, ≥180 days. Demographics were compared by chi-squared; perioperative characteristics, mean PROMs, and postoperative improvement (ΔPROM) were compared using one way ANOVA. MCID achievement rates were compared using simple logistic regression. A secondary analysis was performed by grouping patients by DOS: <180 days, 180-364 days, ≥365 days. Mean PROMs, ΔPROMs, and MCID achievement were similarly compared between DOS groups using one way ANOVA and logistic regression.

Results:

193 patients included. Prevalence of HNP and initial appointment type were significantly associated with TTS(p<0.042, all)(Tables 1 and 2). No significant differences in mean PROMs or ΔPROMs were observed among TTS groups(Tables 3 and 4). MCID achievement was significantly lower for VAS back at 6-months in longest TTS group(Table 4). Mean PROMs were significantly different based on DOS for VAS leg at 6-weeks only(Table 5). MCID achievement was significantly lower for longest DOS group for VAS leg at 6-months only. ΔPROMs did not significantly differ among DOS groups(Table 6).

Conclusion:

Neither TTS nor DOS significantly associated with MIS TLIF outcomes. WC patients may achieve similar clinical improvement even with longer symptom burden and substantial delays in operative treatment.