Preoperative motor weakness and the impact on patient reported outcomes in lateral lumbar interbody fusion

Aayush Kaul; Andrea M Roca; Fatima N Anwar; Jacob C Wolf; Ishan Khosla; Alexandra C Loya; Srinath S Medakkar; Vincent P Federico; Arash J Sayari; Gregory D Lopez; Kern Singh

doi:10.1016/j.jocn.2024.04.033

Preoperative motor weakness and the impact on patient reported outcomes in lateral lumbar interbody fusion

J Clin Neurosci. 2024 May 10:125:7-11. doi: 10.1016/j.jocn.2024.04.033. Online ahead of print.

Affiliations

¹ Chicago Medical School at Rosalind Franklin University of Medicine and Science, 3333 N. Green Bay Rd., North Chicago, IL 60064, United States.
² Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States.
³ Department of Orthopaedic Surgery, Rush University Medical Center, 1611 W. Harrison St. Suite #300, Chicago, IL 60612, United States. Electronic address: kern.singh@rushortho.com.

PMID: 38733901
DOI: 10.1016/j.jocn.2024.04.033

Abstract

This study measures the impact of preoperative motor weakness (MW) on Patient-Reported Outcome Measures (PROMs) in lateral lumbar interbody fusion (LLIF) patients. Retrospectively-sourced data from a prospectively-maintained, single-surgeon database created two cohorts of LLIF patients: patients with/without documented MW. Demographics/perioperative characteristics/PROMs were collected preoperatively and at six-weeks/final follow-up (FF). Studied outcomes were Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form (SF-12) Physical/Mental Component Score (PCS/MCS), Patient Health Questionnaire (PHQ-9), Visual Analog Scale Back/Leg Pain (VAS-BP/LP), and Oswestry Disability Index (ODI). Multivariable linear/logistic regression calculated/compared intercohort minimum clinically important difference (MCID). Mean postoperative follow-up time was 11.5 ± 7.52 months. In total, 214 LLIF patients from December 2010 to May 2023 were included, with 149 having documented MW. In Table 1, self-reported gender was significant between cohorts (p < 0.025). Other significant demographic characteristics were smoker status (p < 0.002), diabetes (p < 0.016), and CCI score (p < 0.011). Table 2 shows notably significant perioperative characteristics: spinal pathology (degenerative spondylolisthesis/foraminal stenosis/herniated nucleus pulposus) (p < 0.005, all), estimated blood loss/length of stay/postoperative day (POD)-zero narcotic consumption (p < 0.001, all). Table 3 outcomes/MCID achievement percentages demonstrated insignificant intercohort differences besides a weakly significant FF ODI score (p < 0.036). MW, a frequently reported symptom in spine surgery, is poorly studied in LLIF patients. Thus, this study evaluates MW impact on PROMs and notes no significant differences. However, one exception regarding FF disability scores was recorded. MW did not affect MCID achievement for our patient population. Therefore, the preliminary findings suggest preoperative MW imparts minimal influence on PROMs/MCID in LLIF patients.

Keywords: Lateral lumbar interbody fusion; Minimum clinically important difference; Motor weakness; Outcomes; PROMs.