Introduction: Success rates of surgical interventions for lumbar disorders vary significantly depending on multiple factors and among them the duration of symptoms (DOS). It is not clear whether there is a “cutoff” time when decompression and fusion surgery becomes less effective in the conditions with chronic nerve root compression symptomatology. The main objective was to analyze if DOS has any effect on clinical outcomes and primarily resolution of radicular pain symptoms due to degenerative disc disease and stenosis with or without spondylolisthesis in patients undergoing transforaminal lumbar interbody fusion (TLIF).
Methods: A prospective observational study was performed. Eighty-four patients with radicular symptoms due to degenerative disc disease, stenosis or spondylolisthesis with no previous fusion surgeries and undergoing one- to three-level TLIF surgeries were enrolled. To emphasize the change in clinical outcome scores, the relevant scores were calculated as the ratio of minimal clinically important difference (MCID) values and change scores. The change scores were calculated by subtracting the postoperative from the baseline scores. Multiple regression analyses were conducted to examine the relationship of DOS and relevant MCID ratio values while controlling for independent variables. Further, a comparison between 2 groups of patients was performed to analyze the changes of clinical outcomes for the patients who underwent fusion within <24 months vs. >24 months.
Results: It was determined that DOS was a significant predictor of better leg pain resolution (p=0.018), but not back pain resolution (p=0.27), or improvement in ODI (p=0.10) and SF-36 PCS scores (p=0.19). The patients with shorter DOS had significantly better radicular symptom resolution (p=0.032) compared to patients who waited 24 months or longer to undergo fusion.
Conclusions: A shorter duration of symptoms was found to be a statistically significant predictor for better resolution of radicular symptoms in patients undergoing TLIF for painful degenerative disc disease, stenosis and spondylolisthesis.
Patient Care: It will help to optimize treatment strategies while improving clinical outcomes for patients undergoing TLIF for painful degenerative disc disease, stenosis and spondylolisthesis
Learning Objectives: The participants will be able to appreciate the effect of shorter duration of symptoms on resolution of radicular symptoms in patients undergoing TLIF for painful degenerative disc disease, stenosis and spondylolisthesis