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

Abstract

Retrospective review. The purpose of this study is to examine the effect of preoperative symptom duration on postoperative clinical outcomes for patients undergoing lumbar fusion surgery. Lumbar fusion surgery can be significantly beneficial for lumbar spondylolisthesis and spinal stenosis. Surgical treatment is typically preceded by some amount of nonoperative intervention and there is no consensus on the optimal timing between symptom onset and surgical intervention. A retrospective review of 144 patients undergoing a one-level to three-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 two years of symptoms. Postoperative outcomes and PROMIS-PF were compared between groups. Univariate and multivariate analyses were performed. Fifty-two (36.1%) had symptoms for two years or longer while 92 (63.9%) had symptoms for less than two 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 two 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 two years or more were 2.4 times less likely to achieve an MCID (OR: 0.42, 95% CI: 0.19-0.92; P =0.031). Patients undergoing lumbar fusion with greater than two years of symptoms before surgery have a smaller increase in PROMIS-PF and are less likely to achieve MCID on PROMIS-PF. Further study is needed to determine the optimal timing for lumbar fusion surgery following symptom onset.