Predicting Factors for Patient Reported Satisfaction after Transforaminal Lumbar Interbody Fusion: A Two-Year Follow-Up

Abstract

Introduction Transforaminal lumbar interbody fusion (TLIF) is an effective treatment of degenerative lumbar spine conditions, to reduce pain and improve function. Understanding predictors of post-operative patient satisfaction is important for better management of patient groups at high risk of dissatisfaction. This study aims to determine the pre-operative predictors of post-operative satisfaction in TLIF surgery. Material and Methods We retrospectively reviewed prospectively collected data on patients who underwent open TLIF for degenerative scoliosis, spondylolisthesis and spinal stenosis from the database of a tertiary hospital between 2008 and 2012 with 2 years follow-up. Clinical outcome was evaluated using Oswestry Disability Index (ODI), North American Spine Society (NASS) Neurogenic Symptom Score (NSS), SF-36 (mean Physical and Mental Health scores), numerical pain rating scale (NPRS) for back and leg pain and two questions from NASS Questionnaire: ((1) Has the surgery met the patient's expectations? (2) How would the patient rate the overall results of treatment?). Paired t-test was used to compare the clinical scores pre-operation and post-operatively at 6 months and 2 years. Univariate and multivariate analyses were conducted to determine significant pre-operative predictors of patient satisfaction at 2 years. Results 217 patients underwent TLIF by a single surgeon during the 5-year period. Mean pre-operative age was 61 and BMI was 25.9. 182 and 35 patients underwent primary TLIF and revision TLIF respectively. 140, 68 and 9 patients underwent single-level, two-level and three-level TLIF respectively. Significant improvement was seen in the post-operative ODI ( p < 0.001), NSS ( p < 0.001), SF-36 (mean physical score; p < 0.001 and mean mental health scores; p < 0.001) and NPRS (back pain; p < 0.001 and leg pain; p < 0.001) scores at 2 years follow-up. 86.8% of patients had their expectations of surgery met and 94.7% of patients were satisfied with the results of treatment at 2 years. Possible indicators identified by univariate analysis for post-operative patient satisfaction ( p < 0.2) were pre-operative scores (NPRS leg pain score, SF-36 Physical Function score, mean Physical Health score and ODI). From multivariate regression model, patients with higher pre-operative NPRS pain score (OR, 1.323; 95% CI, 1.071–1.633; p = 0.009) was more likely to be satisfied at 2 years. Conclusion TLIF surgery provided significant health-related quality of life scores and symptoms improvement in terms of SF-36, ODI, NSS and NPRS (both back pain and leg pain). However, patient reported satisfaction is multi-factorial and their post-operative satisfaction may be largely influenced by expectations of surgery being met and improvement of pain. This highlights the importance of managing patients' expectation pre-operatively as a means of improving post-operative patient satisfaction.