Objective:

To compare perioperative outcomes, PROMs, and minimum clinical important difference (MCID) achievement following single-level TLIF in patients stratified by preoperative comorbidity burden.

Methods:

PROMs were administered preoperatively/postoperatively and included Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and 12-Item Short Form Physical Composite Score (SF-12 PCS). Patients were grouped: preoperative CCI score<5 (mild to moderate comorbidity) or preoperative CCI score≥5 (Severe preoperative comorbidity). A 3:1 propensity score match for age, gender, insurance status, smoking status, and preoperative spinal pathology was utilized to control for significant demographic differences between cohorts.

Results:

Following propensity score match, 255 patients were included (135 in CCI score<5 cohort; 120 in CCI score≥5 cohort). CCI score≥5 cohort demonstrated significantly reduced postoperative VAS back pain on the day of surgery(p<0.001, all). Mean PROM differences were noted for postoperative PROMs: VAS back and ODI 6-months, both instances favoring CCI≥5 cohort(p<0.038). CCI score<5 cohort improved from baseline to 1-year for all postoperative PROMs except SF-12 PCS 6-weeks and 12-weeks and SF-12 MCS 6-weeks(p<0.034, all). CCI score≥5 cohort reported significant improvement from preoperative baseline to the 1-year for all postoperative PROMs except ODI 6-weeks, SF-12 MCS 6-weeks and 1-year, SF-12 PCS 6-weeks, and PROMIS-PF 6-weeks(p<0.017, all). Both cohorts reported greater than 50% overall MCID achievement rate for VAS leg, VAS back, ODI, SF-12 PCS, and PROMIS-PF.

Conclusion:

The results suggest that patients undergoing MIS-TLIF with severe comorbidities can expect similar postoperative trajectory for disability, leg and back pain, and physical function. However, long term (1-year) mental health improvement from preoperative baseline was only noted in the mild to moderate comorbid group.