Patients With Poor Baseline Mental Health May Experience Significant Improvements in Pain and Disability After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A 5-Year Follow-up Study. Issue 5 (June 2020)

• Record Type: Journal Article
• Authors: Goh, Graham Seow-Hng; Liow, Ming Han Lincoln; Yeo, William; Ling, Zhixing Marcus; Yue, Wai-Mun; Guo, Chang-Ming; Tan, Seang-Beng; Chen, John Li-Tat
• Is Part Of: Clinical spine surgery. Volume 33:Issue 5(2020)
• Publication Date: 2020-06
• Subjects: minimally invasive -- lumbar interbody fusion -- TLIF -- mental health -- depression -- clinical outcomes -- return to work -- satisfaction; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000000912
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: A retrospective study using prospectively collected registry data. Objective: Examine the influence of preoperative mental health on outcomes after Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF). Summary of Background Data: Prior studies investigating the relationship between mental health and outcomes after lumbar spine surgery included small cohorts with short follow-up and heterogenous fusion techniques. The effect of MIS-TLIF on mental health also remains unclear. Methods: Prospectively collected registry data of 226 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had completed 5-year follow-up data and were assigned into propensity score-matched groups: poor baseline mental health, that is, low Mental Component Summary (MCS) (<50, n=113) and normal baseline mental health, that is, high MCS (≥50, n=113). Outcomes assessed were visual analog scale for back pain (BP), leg pain (LP), Oswestry Disability Index (ODI), Short-Form 36, North American Spine Society-Neurogenic Symptoms (NS), return to work, return to function, satisfaction, and expectation fulfillment. Length of operation and length of stay were recorded. Results: Preoperative MCS was 40.6±8.2 and 58.5±5.4 in the low and high MCS groups, respectively, after propensity score matching ( P <0.001). At 5 years, the high MCS group had significantly lower LP ( P =0.020) and NS ( P =0.009). Despite a significantly poorer baseline (44.3 vs. 38.7, P =0.007) and 6-month ODI (20.3 vs. 15.7, P =0.018) in the low MCS group, both groups achieved a comparable ODI at 5 years ( P =0.084). There was no significant difference in proportion that achieved minimal clinically important difference for ODI, PCS, BP, and LP ( P >0.05). Both groups reported similar proportions that return to work. However, the low MCS group had a smaller proportion of patients that return to function at 5 years ( P =0.025). Conclusions: Although patients with poorer baseline mental health had greater pain and worse NS preoperatively and up to 5 years postoperatively, a similar proportion experienced a clinically significant improvement in all outcomes. Level of Evidence: Level III—nonrandomized cohort study.