Clinical StudyPractical answers to frequently asked questions in minimally invasive lumbar spine surgery
Introduction
The increasing significance of evidence-based, patient-centered care has led to the introduction of the concept of shared decision-making (SDM). SDM has been defined as: “an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences” [1]. Its benefits include increased patient knowledge leading to realistic expectations and better satisfaction, reduced decisional conflict, reduced rate of choosing surgery, and potentially reduced costs by reducing unnecessary procedures that do not align with patient preferences [2].
Degenerative conditions represent a broad category of lumbar spine pathology with an unclear demarcation between the choices of treatment modalities. Whether to opt for surgery or not largely depends on the extent of symptoms the patient has and the impact of these symptoms on his/her daily life. Patient's preferences and expectations play a major role in decision-making. Considering the requirement of a highly individualized approach for the treatment of lumbar spine degenerative pathology, it is important that physicians have a detailed discussion with the patients and thus, facilitate patient education and SDM.
The advent of minimally invasive spine surgery (MISS) has further broadened the range of treatment options for the treatment of degenerative lumbar pathology [3], [4], [5], [6]. MISS remains a relatively new concept which expectedly leads to queries regarding its risks and benefits. The purpose of this study was, therefore, to provide practical answers to the frequently asked questions (FAQs) patients have when considering minimally invasive lumbar spine surgery for the treatment of degenerative lumbar spine pathology.
Section snippets
Study design and population
This study was an Institutional Review Board-approved retrospective review of prospectively collected data from a multi-surgeon surgical database. Consecutive patients who underwent primary tubular minimally invasive lumbar spine surgery for degenerative conditions in form of transforaminal lumbar interbody fusion (TLIF), decompression alone (unilateral laminectomy for bilateral decompression, ULBD), or tubular microdiscectomy (TMD) between April 2017 and May 2020 at a single institute were
Patient demographics
One hundred four patients were included in the TLIF group (mean age 58.8 years, 53% female, mean BMI 27.5 kg/m2), 147 patients in the decompression group (mean age 64.5 years, 65% male, mean BMI 26.9 kg/m2), and 115 patients in the microdiscectomy group (mean age 45.2 years, 65% male, mean BMI 26.9 kg/m2).
FAQ1: Will my back pain improve?
Back pain had reduced by about 50% after decompression and >50% after TLIF and microdiscectomy. There was a significant improvement in VAS back (p<.001) with most patients achieving MCID
Discussion
From being a legal doctrine focused almost exclusively on the physician's disclosure of information to becoming a process of shared decision-making (SDM) based upon mutual respect and participation, informed consent in health care has evolved incredibly over time. SDM enriches the process of informed consent by emphasizing patients’ understanding and prioritizing of various treatment modalities according to their own values, experiences, and expectations. Beyond improving informed consent, SDM
Declarations of Competing Interests
One or more of the authors declare financial or professional relationships on ICMJE-NASSJ disclosure forms.
Acknowledgments
No direct funding was received for this study. However, the study used REDCap (Research Electronic Data Capture) hosted at Weill Cornell Medicine Clinical and Translational Science Center supported by the National Center For Advancing Translational Science of the National Institute of Health (NIH) under award number: UL1 TR002384.
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FDA device/drug status: Not applicable
Author disclosure: PS: Nothing to disclose. ASV: Nothing to disclose. EM: Nothing to disclose. JKM: Nothing to disclose. SD: Nothing to disclose. JS Nothing to disclose. DJS: Nothing to disclose. DM: Nothing to disclose. KA: Nothing to disclose. HU: Nothing to disclose. AS: Nothing to disclose. VL: Royalties: Nuvasive (C); Stock Ownership: Nemaris Inc. (20%); Stock Ownership: VFT Solutions LLC (50%); Consulting: Globus Medical (F); Consulting: Implanet (B); Consulting: Depuy Synthes Spine (C); Consulting: Stryker (C); Scientific Advisory Board/Other Office: ISSG. (0%) SAQ: Royalties: Globus Medical (C); Private Investments: Tissue Differentiation (F); Private Investments: HS2, LLC (D); Consulting: Globus Medical (E); Consulting: StrykerK2M: (E); Scientific Advisory Board/Other Office: Simplify Medical, Inc. (B). SI: Consulting: Globus Medical, Inc. (C); Consulting: Elliquence (A); Research Support (Investigator Salary, Staff/Materials)^: Innovasive (D).