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

Study design: Retrospective cohort study.

Objective: to analyze trends in PROMs improvement and recovery kinetics following transforaminal endoscopic lumbar discectomy and foraminotomy (TELD).

Summary of background data: 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 to preoperative baseline, there is a paucity of information regarding rate of postoperative improvement.

Methods: Patients who underwent primary one- or two-level TELD for far lateral disc herniations with a minimum of 6-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.

Results: 51 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 2 weeks and 6 weeks, with a plateau after 6 weeks. ODI and SF-12 PCS did not experience statistically significant improvement until 6 weeks, which was also the point of plateau. VAS leg MCID and GRC peaked at 6 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.

Conclusion: Patients can expect the majority of postoperative improvement to occur within 6 weeks, after which improvements tend to plateau. Around 75% of patients feel better compared to preoperative at 6 months. TELD may therefore spare some patients of a more invasive fusion initially.

Level of evidence: 3.