Preoperative Symptom Duration and the Effect on Clinical Outcomes and PROMIS-PF in Patients Undergoing Lumbar Fusion Surgery.

Study Design: Retrospective Review.

Objective: The purpose of this study is to examine the effect of preoperative symptom duration on postoperative clinical outcomes for patients undergoing lumbar fusion surgery.

Summary Of Background Data: Lumbar fusion surgery can be significantly beneficial for lumbar spondylolisthesis and spinal stenosis. Surgical treatment is typically preceded by some amount of non-operative intervention and there isn't a consensus on the optimal timing between symptom onset and surgical intervention.

Methods: A retrospective review of 144 patients undergoing a 1-3 level lumbar fusion from June 2020 to December 2023 was performed. Demographics, preoperative symptom onset, primary diagnosis, and surgical procedure were compared between patients with less than or greater than 2 years of symptoms. Postoperative outcomes and PROMIS-PF were compared between groups. Univariate and multivariate analyses were performed.

Results: 52 (36.1%) had symptoms for 2 years or longer while 92 (63.9%) had symptoms for less than 2 years. There was no difference in demographics, procedure type, primary diagnosis, or preoperative symptoms between those who had symptoms for greater than or less than 2 years. Those who had symptoms for 2+ years had a significantly lower change in PF (4.7±7.1 vs. 7.7±9.0; P=0.029) and lower rate of MCID achievement (44.2% vs. 65.2%; P=0.023). There was no difference in outcomes by symptom duration. On multivariate analysis those with symptoms of 2 years or more were 2.4 times less likely to achieve an MCID (OR: 0.42, 95% CI: 0.19 to 0.92; P=0.031).

Conclusion: Patients undergoing lumbar fusion with greater than 2 years of symptoms prior to surgery have a smaller increase in PROMIS-PF and are less likely to achieve MCID on PROMIS-PF. Further study is needed in order to determine the optimal timing for lumbar fusion surgery following symptom onset.