Objective:

To compare patient-reported outcomes (PROMs), satisfaction, and minimum clinical important difference (MCID) achievement following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) stratified by preoperative disability.

Methods:

MIS-TLIFs were grouped by preoperative ODI score: ODI<41 or ODI≥41. PROMs administered pre/post-operatively: PROMIS-PF, VAS back/leg, ODI, SF-12 PCS/SF-12 MCS. Satisfaction scores were collected for VAS back/leg and ODI. Coarsened exact match controlled for differences between cohorts. T-tests compared mean PROMs and postoperative improvement/satisfaction between cohorts. Simple logistic regression compared MCID achievement.

Results:

After coarsened exact matching, there were 118 patients in ODI≤41 and 377 patients in ODI>41 cohort. ODI>41 cohort saw greater postoperative inpatient VAS pain score and narcotic consumption on days 0/1 (p<0.018, all)(Table 3). PROMs differed between cohorts: PROMIS-PF, SF-12 PCS, ODI, VAS back/leg at all postoperative timepoints and SF-12 MCS at 6-weeks/12-weeks/6-months/1-year (p<0.045, all)(Table 4). Patients in the ODI>41 cohort demonstrated greater proportion achieving MCID for ODI at all postoperative timepoints and for SF-12 MCS 6-week/12-week/6-month/1-year (p <0.040, all)(Table 5). ODI≤41 cohort demonstrated greater MCID achievement for overall PROMIS-PF and SF-12 PCS 6-months (p<0.047, all)(Table 5). Postoperative satisfaction was greater in the ODI≤41 cohort for: VAS leg 6-weeks/12-weeks, VAS back 6-weeks/12-weeks, and ODI all postoperative timepoints (p<0.048, all)(Table 6).

Conclusion:

Preoperative disability associated with worse postoperative PROMs and patient satisfaction for disability, back/leg pain at multiple timepoints. MCID achievement rates across cohorts were similar for most PROMs at most postoperative time-points. Patients with severe disability may have unrealistic expectations for surgical benefits, influencing corresponding postoperative satisfaction.