Surgical outcomes of patients who fail to reach minimal clinically important differences: comparison of minimally invasive versus open transforaminal lumbar interbody fusion

Oliver G. S. Ayling MD1, Y. Raja Rampersaud MD, FRCSC2, Charlotte Dandurand MD, MSc, FRCSC1, Po Hsiang (Shawn) Yuan BSc1, Tamir Ailon MD, MPH1, Nicolas Dea MD, MSc, FRCSC1, Greg McIntosh MSc3, Sean D. Christie MD4, Edward Abraham MD, FRCSC5, Christopher S. Bailey MD6, Michael G. Johnson MD, FRCSC7, Jacques Bouchard MD, FRCSC8, Michael H. Weber MD, PhD9, Jerome Paquet MD, FRCSC10, Joel Finkelstein MD2, Alexandra Stratton MD, MSc, FRCSC11, Hamilton Hall MD, FRCSC2, Neil Manson MD, FRCSC5, Kenneth Thomas MD7, and Charles G. Fisher MD, MHSc, FRCSC1
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  • 1 Department of Surgery, Vancouver General Hospital/University of British Columbia, Vancouver, British Columbia;
  • | 2 Department of Surgery, University of Toronto, Ontario;
  • | 3 Canadian Spine Society, Markdale, Ontario;
  • | 4 Department of Surgery, Dalhousie University, Halifax, Nova Scotia;
  • | 5 Department of Surgery, Canada East Spine Centre, Saint John, New Brunswick;
  • | 6 Department of Surgery, University of Western Ontario, London, Ontario;
  • | 7 Departments of Orthopedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba;
  • | 8 Department of Surgery, University of Calgary, Alberta;
  • | 9 Department of Surgery, McGill University, Montreal, Quebec;
  • | 10 Department of Surgery, Laval University, Quebec City, Quebec; and
  • | 11 Department of Surgery, University of Ottawa, Ontario, Canada
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OBJECTIVE

Treatment of degenerative lumbar diseases has been shown to be clinically effective with open transforaminal lumbar interbody fusion (O-TLIF) or minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Despite this, a substantial proportion of patients do not meet minimal clinically important differences (MCIDs) in patient-reported outcomes (PROs). The objectives of this study were to compare the proportions of patients who did not meet MCIDs after O-TLIF and MIS-TLIF and to determine potential clinical factors associated with failure to achieve MCID.

METHODS

The authors performed a retrospective analysis of consecutive patients who underwent O-TLIF or MIS-TLIF for lumbar degenerative disorders and had been prospectively enrolled in the Canadian Spine Outcomes and Research Network. The authors analyzed the Oswestry Disability Index (ODI) scores, physical and mental component summary scores of SF-12, numeric rating scale (NRS) scores for leg and back pain, and EQ-5D scores of the patients in each group who did not meet the MCID of ODI at 2 years postoperatively.

RESULTS

In this study, 38.8% (137 of 353) of patients in the O-TLIF cohort and 41.8% (51 of 122) of patients in the MIS-TLIF cohort did not meet the MCID of ODI at 2 years postoperatively (p = 0.59). Demographic variables and baseline PROs were similar between groups. There were improvements across the PROs of both groups through 2 years, and there were no differences in any PROs between the O-TLIF and MIS-TLIF cohorts. Multivariable logistic regression analysis demonstrated that higher baseline leg pain score (p = 0.017) and a diagnosis of spondylolisthesis (p = 0.0053) or degenerative disc disease (p = 0.022) were associated with achieving the MCID at 2 years after O-TLIF, whereas higher baseline leg pain score was associated with reaching the MCID after MIS-TLIF (p = 0.038).

CONCLUSIONS

Similar proportions of patients failed to reach the MCID of ODI at 2 years after O-TLIF or MIS-TLIF. Higher baseline leg pain score was predictive of achieving the MCID in both cohorts, whereas a diagnosis of spondylolisthesis or degenerative disc disease was predictive of reaching the MCID after O-TLIF. These data provide novel insights for patient counseling and suggest that either MIS-TLIF or O-TLIF does not overcome specific patient factors to mitigate clinical success or failure in terms of the intermediate-term PROs associated with 1- to 2-level lumbar fusion surgical procedures for degenerative pathologies.

ABBREVIATIONS

CSORN = Canadian Spine Outcomes and Research Network; MCID = minimal clinically important difference; MCS = mental component summary; MIS-TLIF = minimally invasive TLIF; NRS = numeric rating scale; ODI = Oswestry Disability Index; O-TLIF = open TLIF; PCS = physical component summary; PRO = patient-reported outcome; TLIF = transforaminal lumbar interbody fusion.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 407 KB)

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