Influence of Prolonged Duration of Symptoms Before MIS-TLIF in a Workers' Compensation Population

OBJECTIVE: We assessed the potential effect of the preoperative symptom duration on patient-reported out-comes (PROs) for workers' compensation (WC) patients -ndergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).METHODS: WC patients who had undergone primary, elective MIS-TLIF with recorded symptoms duration data available were included. Two cohorts were generated: those with a shorter (lesser) duration (LD; symptom dura-tion <1 year) and those with a prolonged duration (PD; symptom duration >1 year). PROs were collected preoper-atively and at several follow-up points for 51 year post-operatively. The PROs were compared within and between the 2 cohorts. The achievement rates of minimum clinically important differences were also compared between the 2 cohorts.RESULTS: A total of 145 patients were included, with 76 in the PD cohort and 69 in the LD cohort. The LD cohort demonstrated improvement in the patient-reported out-comes measurement information system for physical function (PROMIS-PF) at 6 months and 1 year post-operatively, Oswestry disability index (ODI) at 12 weeks and 6 months postoperatively, visual analog scale (VAS) score for back pain at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for leg pain at all post-operative points (P 5 0.015 for all). The PD cohort demon-strated improvement in the PROMIS-PF at 12 weeks and 6 months postoperatively, ODI at 6 weeks, 12 weeks, and 6 months postoperatively, and VAS score for back pain and leg pain at all postoperative periods (P 5 0.007 for all). All the preoperative PROs were superior for the LD cohort (P< 0.001 for all). The LD cohort reported better PROMIS-PF at 6 months and 1 year and ODI at 1 year postoperatively (P 5 0.037 for all). The PD cohort was more likely to achieve a minimum clinically important difference in ODI at 6 and 12 weeks postoperatively, VAS score for back pain at 6 weeks postoperatively, and VAS score for leg pain at 6 weeks and 1 year postoperatively and overall (P5 0.036 for all).CONCLUSIONS: Independently of the preoperative symptom duration, WC patients demonstrated improvement in physical function and pain after MIS-TLIF. Patients with a longer symptom duration reported inferior function and pain preoperatively and were more likely to demonstrate clinically significant improvements in disability and pain postoperatively.

Automated summary

This study assessed the potential effect of preoperative symptom duration on patient-reported outcomes for workers' compensation patients undergoing MIS-TLIF. The results showed that patients with longer symptom duration had more severe preoperative dysfunction and pain, and also demonstrated greater improvements postoperatively.