Patients With Poor Baseline Mental Health May Experience Significant Improvements in Pain and Disability After Minimally Invasive Transforaminal Lumbar Interbody Fusion: A 5-Year Follow-up Study.

Study Design: A retrospective study using prospectively collected registry data.

Objective: Examine the influence of preoperative mental health on outcomes after Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF).

Summary Of Background Data: Prior studies investigating the relationship between mental health and outcomes after lumbar spine surgery included small cohorts with short follow-up and heterogenous fusion techniques. The effect of MIS-TLIF on mental health also remains unclear.

Methods: Prospectively collected registry data of 226 patients who underwent single-level MIS-TLIF at a single institution were reviewed. Patients had completed 5-year follow-up data and were assigned into propensity score-matched groups: poor baseline mental health, that is, low Mental Component Summary (MCS) (<50, n=113) and normal baseline mental health, that is, high MCS (≥50, n=113). Outcomes assessed were visual analog scale for back pain (BP), leg pain (LP), Oswestry Disability Index (ODI), Short-Form 36, North American Spine Society-Neurogenic Symptoms (NS), return to work, return to function, satisfaction, and expectation fulfillment. Length of operation and length of stay were recorded.

Results: Preoperative MCS was 40.6±8.2 and 58.5±5.4 in the low and high MCS groups, respectively, after propensity score matching (P<0.001). At 5 years, the high MCS group had significantly lower LP (P=0.020) and NS (P=0.009). Despite a significantly poorer baseline (44.3 vs. 38.7, P=0.007) and 6-month ODI (20.3 vs. 15.7, P=0.018) in the low MCS group, both groups achieved a comparable ODI at 5 years (P=0.084). There was no significant difference in proportion that achieved minimal clinically important difference for ODI, PCS, BP, and LP (P>0.05). Both groups reported similar proportions that return to work. However, the low MCS group had a smaller proportion of patients that return to function at 5 years (P=0.025).

Conclusions: Although patients with poorer baseline mental health had greater pain and worse NS preoperatively and up to 5 years postoperatively, a similar proportion experienced a clinically significant improvement in all outcomes.

Level Of Evidence: Level III-nonrandomized cohort study.