Evaluating the Effect of Preoperative Symptom Duration on Patient-Reported Outcomes Following Anterior Lumber Interbody Fusion.
Academic Article
Overview
abstract
INTRODUCTION: Anterior lumbar interbody fusion (ALIF) continues to grow as a cornerstone treatment option for degenerative lumbar spine pathologies. The relationship between preoperative symptom duration and outcomes following ALIF is not well established. The purpose of this study is to assess the effect of preoperative symptom duration on postoperative functional and pain outcomes following ALIF. METHODS: This was a retrospective cohort study including patients who underwent primary one- or two-level ALIF at a single academic institution between 2017 and 2023. Patients were grouped into shorter (<12 months) and prolonged (≥12 months) cohorts based on preoperative symptom duration. Outcomes included Oswestry disability index (ODI), visual analog scale Back and Leg, and 12-Item Short Form Survey (SF-12) physical component score. Change in patient-reported outcome measure scores and minimal clinically important difference (MCID) rates were calculated. Analyses were conducted on the early (<6-months) and late (≥6 months) postoperative periods. RESULTS: A total of 145 patients (52.8 ± 12.8 years, 55.5% female) were included. In the early postoperative period, the shorter preoperative symptom duration cohort experienced markedly greater improvement from preoperative patient-reported outcome measure scores compared with the prolonged symptom duration cohort for ODI, VAS-Back, and VAS-Leg. The shorter symptom duration cohort achieved MCID in the early and late postoperative periods at a markedly higher rate for ODI (early: 80.5% vs. 25.0%, P < 0.001; late: 88.9% vs. 64.8%, P = 0.008). On multivariable regression analysis, prolonged preoperative symptom duration (≥12 months; odds ratio: 3.69, P = 0.006) was identified as an independent predictor for failure to achieve MCID for ODI at latest follow-up. CONCLUSION: Our study demonstrates improved clinical outcomes for patients with shorter preoperative symptom duration undergoing ALIF, suggesting that delayed surgical intervention may result in worse outcomes and greater postoperative disability. These findings may help inform the approach to counseling patients on postoperative expectations and outcomes based on their preoperative symptom duration.
