Comparison of Patient Reported Outcome Measures and MCID Achievement in Patients With Radiculopathy Undergoing Open Versus MIS TLIF

Abstract

Study Design Retrospective Cohort Study. Objective To compare postoperative outcomes between open versus minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) in patients with predominant radiculopathy symptoms. Methods All adult patients undergoing open and MIS single level TLIF (2017-2024) were retrospectively identified. Patients were included if they had preoperative and 1-year postoperative patient reported outcome measures (PROMs). Patients with predominant radiculopathy symptoms were identified if their preoperative Visual Analog Scale (VAS) leg score was greater than their VAS back score. Results A total of 220 patients were included (open TLIF: 155; MIS TLIF: 65). Patients had similar age, sex, race, BMI, and CCI (all p>0.05). Patients in the MIS cohort more frequently had PPO/HMO insurance (55.4% versus 39.0%; P = 0.034). Regarding surgical characteristics, patients who underwent MIS TLIF had shorter length of stay (LOS) (1.71 versus 2.39 days; P < 0.001), proportionally greater routine discharge home (98.2% versus 87.1%; P = 0.005), and decreased estimated blood loss (EBL) (64.1 versus 292 mL; P < 0.001). There were no differences in postoperative PROM values, delta PROM values, or achievement of minimal clinically important difference between groups. Conclusion Despite similar postoperative clinical outcomes, patients with predominant radiculopathy symptoms undergoing MIS TLIF had favorable LOS, discharge disposition, and EBL compared to patients undergoing open TLIF.