Temporal Changes in PROMs Improvement and Recovery Kinetics Following Transforaminal Endoscopic Lumbar Discectomy

Retrospective cohort study.

The objective is to analyze trends in PROMs improvement and recovery kinetics following transforaminal endoscopic lumbar discectomy and foraminotomy (TELD).

As TELDs become an increasingly common alternative to fusions for lateral disc herniations, it is important to understand patients' postoperative recovery timelines to manage patient expectations. Although studies have shown improvement after TELD compared with preoperative baseline, there is a paucity of information regarding rate of postoperative improvement.

Patients who underwent primary one-level or two-level TELD for far lateral disc herniations with a minimum of six-month follow-up were included. Outcomes included: patient-reported outcome measures (PROMs), including Oswestry disability index (ODI), 12-Item Short Form Survey Physical Component Score (SF-12 PCS), and visual analog scale (VAS) for back and leg; PROMs minimally clinically important difference (MCID); global rating of change (GRC); and return to activities. Timepoints included were preoperative, 2 weeks, 6 weeks, 12 weeks, 6 months. Trends in improvement were plotted on graphs and with P- values displayed in tables.

Fifty-one patients were included. Mean operative time was 68.4±23.0 minutes and mean length of stay was 9.6±10.5 hours. There were statistically significant improvements in VAS back and leg at two and six weeks, with a plateau after six weeks. ODI and SF-12 PCS did not experience statistically significant improvement until six weeks, which was also the point of plateau. VAS leg MCID and GRC peaked at six weeks. All patients returned to driving and discontinued opioids, and most patients returned to work. Median days to return to driving, work, and discontinue opioids were 8, 35, and 1, respectively.

Patients can expect the majority of postoperative improvement to occur within six weeks, after which improvements tend to plateau. Around 75% of patients feel better compared with preoperative at six months. TELD may therefore spare some patients of a more invasive fusion initially.

Level III.