Purpose

To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Methods

Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss.

Results

A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50 years, workers’ compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110 min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain.

Conclusion

The results of this study suggest that younger age, workers’ compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed.

Graphic abstract

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中文翻译：

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确定微创经椎间孔腰椎椎体间融合术后术后疼痛加剧的危险因素。

目的

为了评估与微创经椎间孔腰椎椎体间融合术（MIS TLIF）后住院疼痛评分较高相关的特定人口统计学和围手术期变量。

方法

回顾性分析了接受单级，主要MIS TLIF的患者。收集围手术期结局，并测量术后住院VAS疼痛评分。具有稳健的误差方差的双变量和逐步多元Poisson回归均用于评估平均住院患者疼痛评分≥5.0的危险因素。使用年龄，性别，吸烟状况，糖尿病状况，保险状况，BMI，合并症负担，椎弓根螺钉侧面性，手术时间和估计失血量，创建了最终的向后逐步回归模型。

结果

总共纳入了255例接受原发性单水平MIS TLIF的患者。年龄小于50岁，工人补偿保险，术前VAS疼痛评分≥7和手术持续时间≥110分钟与术后疼痛加剧有关。然而，其他变量，如性别，BMI，吸烟状况，合并症负担，糖尿病状况和椎弓根螺钉侧倾与术后疼痛增加无关。

结论

这项研究的结果表明，TLIF后较年轻的年龄，工人的报酬，术前疼痛评分的升高和手术时间的延长均与住院患者的疼痛加剧有关。外科医生可以使用此信息来更好地评估TLIF后哪些患者可能需要进一步的疼痛控制。患者对术后疼痛和恢复的期望也可能得到更好的管理。

图形摘要

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