BACKGROUND CONTEXT

Surgical counseling enables shared decision-making (SDM) by improving patients’ understanding.

PURPOSE

To provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery.

STUDY DESIGN

Retrospective review of prospectively collected data.

PATIENT SAMPLE

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.

OUTCOME MEASURES

(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)

METHODS

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) and late (>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 (<6 months) and late (≥6 months) postoperative time points were analyzed within each of the three groups. Percentage of patients achieving MCID was also evaluated.

RESULTS

Three hundred sixty-six 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%. 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 is likely to be acceptable and nearly insignificant in terms of radiation-related risks. (6) What is the likelihood that I will have a complication? 17.3% (15.4% minor, 1.9% major) for TLIF, 10% (9.3% minor and 0.7% major) for decompression, and 1.7% (all minor) for microdiscectomy (7) Will I need another surgery? Six percent 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).

CONCLUSIONS

These concise answers to the FAQs in minimally invasive lumbar spine surgery can be used by physicians as a reference to enable patient education.

中文翻译：

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腰椎微创手术常见问题的实用解答

背景语境

手术咨询通过提高患者的理解来实现共同决策 (SDM)。

目的

提供微创腰椎手术中常见问题 (FAQ) 的答案。

学习规划

对前瞻性收集的数据进行回顾性审查。

患者样本

接受经椎间孔腰椎椎体间融合术 (MI-TLIF) 形式的原发性管状微创腰椎手术、单纯减压或显微椎间盘切除术的患者，并进行了至少 1 年的随访。

结果测量

(1) 手术（辐射暴露和术中并发症） (2) 术后即刻（住院时间 [LOS] 和并发症） (3) 临床结果（视觉模拟比例背部和腿部，VAS；Oswestry 功能障碍指数，ODI；12-项目简表调查物理成分评分，SF-12 PCS；患者报告的结果测量信息系统物理功能，PROMIS PF；全球评级变化，GRC；恢复活动；并发症/再次手术）

方法

对结果测量进行了分析，以提供十个常见问题的答案，这些常见问题是根据作者的经验和对文献的回顾而编制的。使用 Wilcoxon 符号秩检验分析VAS 背部、VAS 腿部、ODI 和 SF-12 PCS 从术前值到术后早期（<6 个月）和晚期（> 6个月）时间点的变化。评估了在两个时间点实现这些患者报告的结果测量 (PROM) 的最小临床重要差异 (MCID) 的患者百分比。在三组中的每一组中分析术后时间点过早（<6 个月）和晚期（≥6 个月）的 PROs 从术前值的变化。还评估了达到 MCID 的患者百分比。

结果

包括 366 名患者（104 名 TLIF，147 名减压，115 名显微椎间盘切除术）。回答了以下常见问题： (1) 我的背痛会好转吗？大多数患者报告改善 >50%。约 60% 的 TLIF、减压和显微椎间盘切除术患者在 ≥ 6 个月时达到 MCID。(2) 我的腿痛会好转吗？大多数患者报告改善 >50%。56% 的 TLIF、67% 的减压和 70% 的显微椎间盘切除术患者在 ≥ 6 个月时达到 MCID。(3) 我的活动水平会提高吗？大多数患者报告有显着改善。66% 的 TLIF、55% 的减压和 75% 的显微椎间盘切除术患者实现了 SF-12 PCS 的 MCID。(4) 我有可能变得更糟吗？TLIF 后为 6%，减压后为 14%，显微椎间盘切除术后为 5%。(5) 我会受到大量辐射吗？就与辐射相关的风险而言，辐射暴露可能是可以接受的并且几乎可以忽略不计。(6) 我出现并发症的可能性有多大？17.3%（15.4% 次要，1.9% 主要）用于 TLIF，10%（9.3% 次要和 0.7% 主要）用于减压，1.7%（全部次要）用于显微椎间盘切除术 (7) 我是否需要再次手术？TLIF 后为 6%，减压后为 16.3%，显微椎间盘切除术后为 13%。(8) 我要住院多长时间？大多数患者在 TLIF 术后第一天以及减压和显微椎间盘切除术后的同一天出院。(9) 我什么时候可以重返工作岗位？>80% 的患者重返工作岗位（平均：TLIF 后 25 天，减压后 14 天，显微椎间盘切除术后 11 天）。(10) 我还能开车吗？>

结论

这些对微创腰椎手术常见问题解答的简明解答可供医生作为参考，以实现对患者的教育。