General Session: Thoraco-Lumbar Degenerative

Presented by: A. Narain - View Audio/Video Presentation (Members Only)

Author(s):

A. Narain(1), F. Hijji(1), B. Mayo(1), K. Yom(1), K. Kudaravalli(1), N. Shoshana(1), K. Singh(1)

(1) Rush University Medical Center, Orthopaedic Surgery, Chicago, IL, United States

Abstract

Introduction: Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) has been demonstrated to be an effective treatment for lower back pain as both a primary and revision procedure. However, inpatient pain scores and narcotic consumption as they relate to primary and revision MIS TLIF have not been previously reported. Therefore, the objective of this study is to examine patient-reported inpatient pain scores and narcotics consumption after primary and revision MIS TLIF.

Methods: A prospectively maintained surgical database of patients who underwent a single-level primary or revision MIS TLIF for degenerative spinal pathology between 2010-2016 was reviewed. Procedure type was tested for association with demographics and preoperative characteristics using student's t-test and chi squared tests for continuous and categorical variables, respectively. Inpatient pain scores and narcotics consumption on each postoperative day between cohorts were then compared using linear regression adjusted for patient demographics and preoperative characteristics.

Results: A total of 407 patients were included in this analysis, of which 303 (74.45%) underwent primary MIS TLIF and 104 (25.55%) underwent reoperation MIS TLIF after failed decompression. The patients in the reoperation cohort were younger (47.90 vs 52.67 years, p< 0.001), more likely to be male (76.92% vs 58.09%, p=0.001), more likely to be smokers (26.21% vs 16.17%, p=0.024), had a lower comorbidity index (1.60 vs 2.14, p=0.013), and were more likely to carry Workers' Compensation as their primary payer (54.81% vs 39.93%, p=0.008). Reoperation patients experienced shorter operative times (103.73 vs 115.73 min, p=0.005) and decreased lengths of hospitalization (45.93 vs 56.85 hours, p=0.005). There were no statistically significant differences in inpatient visual analog scale (VAS) pain scores, daily oral morphine equivalent (OME) consumption, or hourly OME consumption on any postoperative day between cohorts (p>0.05 for each).

Conclusions: The results of this study suggest that patients undergoing a single-level revision MIS TLIF following a failed lumbar decompression experience similar inpatient pain scores and narcotic consumption as patients undergoing a single-level primary MIS TLIF despite being younger and having a lower comorbidity burden. As such, patients undergoing revision MIS TLIF should receive a similar postoperative pain regimen as those undergoing a primary MIS TLIF.

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