Time to achievement of minimum clinically important difference after lumbar decompression.

Area of Science:

• Spine surgery
• Patient-reported outcomes
• Clinical outcomes research

Background:

• Lumbar decompression (LD) is a common surgical procedure for spinal conditions.
• Assessing patient recovery using Minimum Clinically Important Difference (MCID) is crucial for evaluating surgical success.
• Understanding factors influencing the time to achieve MCID can optimize patient care and expectations.

Purpose of the Study:

• To investigate preoperative factors associated with the time to achieve MCID for Oswestry Disability Index (ODI), Visual Analog Scale (VAS) back, and VAS leg pain after LD.
• To identify predictors of early versus late MCID achievement in patients undergoing LD.

Main Methods:

• Retrospective review of 343 patients undergoing LD from April 2016 to January 2021.
• Utilized established MCID values to determine achievement.
• Kaplan-Meier survival analysis and multivariable Cox regression were employed to analyze time to MCID and identify predictive factors.

Main Results:

• Overall MCID achievement rates were approximately 65-67% for ODI, VAS back, and VAS leg.
• Mean time to MCID achievement ranged from approximately 19 to 23 weeks.
• Active smoking, baseline PROMIS-PF, ODI, VAS back, and VAS leg predicted early MCID achievement.
• ASA class 2, Black ethnicity, workers' compensation, private insurance, and foraminal stenosis diagnosis predicted late MCID achievement.

Conclusions:

• Most patients achieved MCID within six months post-LD.
• Active smoking and baseline patient-reported outcomes are significant predictors of early recovery.
• Demographic factors, insurance status, and specific diagnoses influence the timeline for achieving meaningful improvement.