ABSTRACT
Background Context
Although some previous studies have analyzed predictors of nonimprovement, most of
these have focused on demographic and clinical variables and have not accounted for
radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement.
Purpose
To identify the risk factors and predictors (both radiological and nonradiological)
for slower as well as nonachievement of minimal clinically important difference (MCID)
after minimally invasive decompression.
Design
Retrospective cohort.
Patient Sample
Patients who underwent minimally invasive decompression for degenerative lumbar spine
conditions and had a minimum of 1-year follow-up were included. Patients with preoperative
Oswestry Disability Index (ODI) <20 were excluded.
Outcome Measure
MCID achievement in ODI (cut off 12.8).
Methods
Patients were stratified into two groups (achieved MCID, did not achieve MCID) at
two timepoints (early ≤3 months, late ≥6 months). Nonradiological (age, gender, BMI,
comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative
back pain) and radiological (MRI – Schizas grading for stenosis, dural sac cross-sectional
area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier
grading, facet cyst/effusion; X-ray – spondylolisthesis, lumbar lordosis, spinopelvic
parameters) variables were assessed with comparative analysis to identify risk factors
and with multiple regression models to identify predictors for slower achievement
of MCID (MCID not achieved by ≤3 months) and nonachievement of MCID (MCID not achieved
at ≥6 months).
Results
A total of 338 patients were included. At ≤3 months, patients who did not achieve
MCID had significantly lower preoperative ODI (40.1 vs. 48.1, p<0.001) and worse psoas
Goutallier grading (p=.048). At ≥6 months, patients who did not achieve MCID had significantly
lower preoperative ODI (38 vs. 47.5, p<.001), higher age (68 vs. 63 years, p=.007),
worse average L1-S1 Pfirrmann grading (3.5 vs. 3.2, p=.035), and higher rate of pre-existing
spondylolisthesis at the operated level (p=.047). When these and other probable risk
factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier
grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late
timepoint came out as independent predictors for MCID nonachievement.
Conclusion
After minimally invasive decompression, low preoperative ODI and poor muscle health
are risk factors and predictors for slower achievement of MCID. For nonachievement
of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis
are risk factors and low preoperative ODI is the only independent predictor.
Key words
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Article info
Publication history
Published online: April 11, 2023
Accepted:
April 7,
2023
Received in revised form:
February 27,
2023
Received:
January 10,
2023
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
SS: Nothing to disclose. PS: Nothing to disclose. TA: Nothing to disclose. AK: Nothing to disclose. TS: Nothing to disclose. EZ: Nothing to disclose. AK: Nothing to disclose. OM: Nothing to disclose. KA: Nothing to disclose. NS: Nothing to disclose. OT: Nothing to disclose. MK: Nothing to disclose. RK: Nothing to disclose. ES: Nothing to disclose. JD: Nothing to disclose. SQ: Royalties: Globus Medical (C); Private Investments: Tissue Differentiation (E), HS2, LLC (D); Consulting: Globus Medical (E), Stryker K2M (E); Scientific Advisory Board/Other Office: Simplify Medical, INC (B). SI: Royalties: Globus Medical (C); Private Investments: Tissue Differentiation (E), HS2, LLC (D); Consulting: Globus Medical (E), Stryker K2M (E); Scientific Advisory Board/Other Office: Simplify Medical, INC (B).
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