Practical Answers to Frequently Asked Questions in Minimally Invasive Lumbar Spine Surgery — The International Society for the Study of the Lumbar Spine
  1. Schedule
  2. GENERAL POSTER SESSION
  3. Practical Answers to Frequently Asked Questions in Minimally Invasive Lumbar Spine Surgery

Practical Answers to Frequently Asked Questions in Minimally Invasive Lumbar Spine Surgery (#1132)

Avani Vaishnav 1 , Pratyush Shahi 1 , Eric Mai 1 , Jeong Hoon Kim 2 , Virginie Lafage 1 , Sravisht Iyer 1 2 , Sheeraz Qureshi 1 2
  1. Hospital for Special Surgery, New York, NY, United States
  2. Weill Cornell Medical College, New York

Introduction: Surgical counseling enables shared decision-making (SDM) by improving patients’ understanding. The purpose of this study was to provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery.

Methods: This was a retrospective review of prospectively collected data from a single-surgeon surgical database. Consecutive patients who underwent primary minimally invasive lumbar spine surgery in form of transforaminal lumbar interbody fusion (TLIF), decompression alone (unilateral laminectomy for bilateral decompression), or tubular microdiscectomy were selected. Only single-level TLIFs were included, whereas for decompression and microdiscectomy, patients were included irrespective of the number of levels operated. All patients had a minimum of 1-year follow-up. A list of ten FAQs was compiled. 

Patient demographics, surgical data (type of surgery, radiation exposure, and intraoperative complications), postoperative in-hospital data (postoperative length of stay [LOS] and complications) and  post-discharge data (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) were analyzed.

Changes in VAS back, VAS leg, ODI, and SF-12 PCS from preoperative values to the early (<6 months) and late (>6 months) timepoints were analyzed with Wilcoxon Signed Rank Tests. The percentage of patients achieving minimal clinically important difference (MCID) for these patient-reported outcome measures (PROMs) at the two timepoints was also evaluated.

Results: 366 patients (104 TLIF, 147 decompression, 115 microdiscectomy) were included. The following FAQs were answered:

  1. Will my back pain improve? Most patients report improvement by >50%. 
  2. Will my leg pain improve? Most patients report improvement by >50%.
  3. Will my activity level improve? Most patients report significant improvement.
  4. Is there a chance I will get worse? 6% after TLIF, 14% after decompression, and 5% after microdiscectomy.
  5. Will I receive a significant amount of radiation? The radiation exposure is likely to be tolerable and nearly insignificant in terms of radiation-related risks.
  6. What is the likelihood that I will have a complication? 17% (15% minor, 2% major) for TLIF, 10% (9.3% minor and 0.7% major) for decompression, 1.7% (all minor) for microdiscectomy.
  7. Will I need another surgery? 6% after TLIF, 16.3% after decompression, 13% after microdiscectomy. 
  8. How long will I stay in the hospital? Most patients get discharged on postoperative day one after TLIF and on the same day after decompression and microdiscectomy.
  9. When will I be able to return to work? >80% of patients return to work (average: 25 days after TLIF, 14 days after decompression, 11 days after microdiscectomy).
  10. Will I be able to drive again? >90% of patients return to driving (average: 22 days after TLIF, 11 days after decompression, 14 days after microdiscectomy).

Conclusion: The above list provides concise answers to ten FAQs in minimally invasive lumbar spine surgery. We believe that this can be used by physicians as a reference to enable patient education and SDM.

 

 

#ISSLS2022