Practical answers to frequently asked questions in minimally invasive lumbar spine surgery

• Published in: The spine journal 2023-01, Vol.23 (1), p.54-63
• Main Authors: Shahi, Pratyush, Vaishnav, Avani S., Mai, Eric, Kim, Jeong Hoon, Dalal, Sidhant, Song, Junho, Shinn, Daniel J., Melissaridou, Dimitra, Araghi, Kasra, Urakawa, Hikari, Sivaganesan, Ahilan, Lafage, Virginie, Qureshi, Sheeraz A., Iyer, Sravisht
• Format: Article
• Language: English
• Subjects: Decompression; Frequently asked questions; Humans; Lumbar Vertebrae - surgery; Lumbosacral Region - surgery; Minimally invasive lumbar spine surgery; Minimally Invasive Surgical Procedures - adverse effects; Patient-reported outcomes; Retrospective Studies; Shared decision-making; Spinal Fusion - adverse effects; Transforaminal lumbar interbody fusion; Treatment Outcome; Tubular microdiscectomy
• ISSN: 1529-9430; 1878-1632; 1878-1632
• DOI: 10.1016/j.spinee.2022.07.087

Surgical counseling enables shared decision-making (SDM) by improving patients’ understanding. To provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery. Retrospective review of prospectively collected data. Patients who underwent primary tubular minimally invasive lumbar spine surgery in form of transforaminal lumbar interbody fusion (MI-TLIF), decompression alone, or microdiscectomy and had a minimum of 1-year follow-up. (1) Surgical (radiation exposure and intraoperative complications) (2)Immediate postoperative (length of stay [LOS] and complications) (3) Clinical outcomes (Visual Analog Scale- back and leg, VAS; Oswestry Disability Index, ODI; 12-Item Short Form Survey Physical Component Score, SF-12 PCS; Patient-Reported Outcomes Measurement Information System Physical Function, PROMIS PF; Global Rating Change, GRC; return to activities; complications/reoperations) The outcome measures were analyzed to provide answers to ten FAQs that were compiled based on the authors’ experience and a review of literature. Changes in VAS back, VAS leg, ODI, and SF-12 PCS from preoperative values to the early (6 months) postoperative time points were analyzed with Wilcoxon Signed Rank Tests. % of patients achieving minimal clinically important difference (MCID) for these patient-reported outcome measures (PROMs) at the two time points was evaluated. Changes in PROs from preoperative values too early (50%. About 60% of TLIF, decompression, and microdiscectomy patients achieved MCID at ≥6 months. (2) Will my leg pain improve? Most patients report improvement by >50%. 56% of TLIF, 67% of decompression, and 70% of microdiscectomy patients achieved MCID at ≥6 months. (3) Will my activity level improve? Most patients report significant improvement. Sixty-six percent of TLIF, 55% of decompression, and 75% of microdiscectomy patients achieved MCID for SF-12 PCS. (4) Is there a chance I will get worse? Six percent after TLIF, 14% after decompression, and 5% after microdiscectomy. (5) Will I receive a significant amount of radiation? The radiation exposure