PMID- 37059307 OWN - NLM STAT- MEDLINE DCOM- 20230718 LR - 20230718 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 23 IP - 8 DP - 2023 Aug TI - Poor muscle health and low preoperative ODI are independent predictors for slower achievement of MCID after minimally invasive decompression. PG - 1152-1160 LID - S1529-9430(23)00157-2 [pii] LID - 10.1016/j.spinee.2023.04.004 [doi] AB - BACKGROUND CONTEXT: Although some previous studies have analyzed predictors of nonimprovement, most of these have focused on demographic and clinical variables and have not accounted for radiological predictors. In addition, while several studies have examined the degree of improvement after decompression, there is less data on the rate of improvement. PURPOSE: To identify the risk factors and predictors (both radiological and nonradiological) for slower as well as nonachievement of minimal clinically important difference (MCID) after minimally invasive decompression. DESIGN: Retrospective cohort. PATIENT SAMPLE: Patients who underwent minimally invasive decompression for degenerative lumbar spine conditions and had a minimum of 1-year follow up were included. Patients with preoperative Oswestry Disability Index (ODI) <20 were excluded. OUTCOME MEASURE: MCID achievement in ODI (cut off 12.8). METHODS: Patients were stratified into two groups (achieved MCID, did not achieve MCID) at two timepoints (early /=6 months). Nonradiological (age, gender, BMI, comorbidities, anxiety, depression, number of levels operated, preoperative ODI, preoperative back pain) and radiological (MRI - Schizas grading for stenosis, dural sac cross-sectional area, Pfirrmann grading for disc degeneration, psoas cross-sectional area and Goutallier grading, facet cyst/effusion; X-ray - spondylolisthesis, lumbar lordosis, spinopelvic parameters) variables were assessed with comparative analysis to identify risk factors and with multiple regression models to identify predictors for slower achievement of MCID (MCID not achieved by /=6 months). RESULTS: A total of 338 patients were included. At /=6 months, patients who did not achieve MCID had significantly lower preoperative ODI (38 vs 47.5, p<.001), higher age (68 vs 63 years, p=.007), worse average L1-S1 Pfirrmann grading (3.5 vs 3.2, p=.035), and higher rate of pre-existing spondylolisthesis at the operated level (p=.047). When these and other probable risk factors were put into a regression model, low preoperative ODI (p=.002) and poor Goutallier grading (p=.042) at the early timepoint and low preoperative ODI (p<.001) at the late timepoint came out as independent predictors for MCID nonachievement. CONCLUSION: After minimally invasive decompression, low preoperative ODI and poor muscle health are risk factors and predictors for slower achievement of MCID. For nonachievement of MCID, low preoperative ODI, higher age, greater disc degeneration, and spondylolisthesis are risk factors and low preoperative ODI is the only independent predictor. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Singh, Sumedha AU - Singh S AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Shahi, Pratyush AU - Shahi P AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Asada, Tomoyuki AU - Asada T AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Kaidi, Austin AU - Kaidi A AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Subramanian, Tejas AU - Subramanian T AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. FAU - Zhao, Eric AU - Zhao E AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. FAU - Kim, Ashley Yeo Eun AU - Kim AYE AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. FAU - Maayan, Omri AU - Maayan O AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. FAU - Araghi, Kasra AU - Araghi K AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Singh, Nishtha AU - Singh N AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Tuma, Olivia AU - Tuma O AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Korsun, Maximilian AU - Korsun M AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Kamil, Robert AU - Kamil R AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Sheha, Evan AU - Sheha E AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Dowdell, James AU - Dowdell J AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Qureshi, Sheeraz AU - Qureshi S AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA. FAU - Iyer, Sravisht AU - Iyer S AD - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. Electronic address: sravisht@gmail.com. LA - eng GR - UL1 TR002384/TR/NCATS NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20230412 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Humans MH - Middle Aged MH - *Intervertebral Disc Degeneration/diagnostic imaging/surgery/etiology MH - *Spondylolisthesis/diagnostic imaging/surgery/etiology MH - Retrospective Studies MH - Treatment Outcome MH - Minimal Clinically Important Difference MH - *Spinal Fusion/adverse effects MH - Lumbar Vertebrae/surgery MH - Muscles MH - Decompression OTO - NOTNLM OT - Failure OT - Laminectomy OT - Lumbar decompression OT - MCID OT - ODI OT - Predictors OT - Radiological OT - Risk factors OT - Slower improvement COIS- Declaration of competing interest One or more of the authors declare financial or professional relationships on ICMJE-TSJ disclosure forms. EDAT- 2023/04/15 06:00 MHDA- 2023/07/18 13:07 CRDT- 2023/04/14 19:27 PHST- 2023/01/10 00:00 [received] PHST- 2023/02/27 00:00 [revised] PHST- 2023/04/07 00:00 [accepted] PHST- 2023/07/18 13:07 [medline] PHST- 2023/04/15 06:00 [pubmed] PHST- 2023/04/14 19:27 [entrez] AID - S1529-9430(23)00157-2 [pii] AID - 10.1016/j.spinee.2023.04.004 [doi] PST - ppublish SO - Spine J. 2023 Aug;23(8):1152-1160. doi: 10.1016/j.spinee.2023.04.004. Epub 2023 Apr 12.