To demonstrate whether preoperative mental health
status can be predictive of postoperative functional outcomes as measured by Patient-Reported Outcome Measurement Information System Physical Function (PROMIS
PF) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF
Summary of Background Data.
There is a paucity of scientific investigations into the association between preoperative mental health
as evaluated by a validated questionnaire such as the Short Form-12 Mental Health
Composite Score (SF-12
MCS) and postoperative outcomes following MIS TLIF
Patients undergoing a primary MIS TLIF
were retrospectively reviewed and stratified into cohorts based on preoperative SF-12
MCS scores. The Physical Function scores of PROMIS
, of which there are other domains including Pain Interference, Sexual Function, and Cognitive Function, were compared between the cohorts. In addition, the improvement in PROMIS
scores based on preoperative SF-12
MCS scores following MIS TLIF
was analyzed using multivariate linear regression.
One hundred seventy-two patients were included: 85 patients (49.4%) had a preoperative SF-12
MCS score <50 and 87 (50.6%) had a preoperative SF-12
MCS score ≥50. Patients with poorer mental health
demonstrated significantly worse PROMIS
PF scores preoperatively (33.8 vs.
< 0.001), as well as at all postoperative timepoints: 6-weeks (35.1 vs.
< 0.001), 3-months (38.9 vs.
< 0.001), 6-months (41.4 vs.
< 0.001), and 1-year (42.4 vs.
< 0.001). However, at the 1-year timepoint, patients with worse mental health
reported experiencing significantly less improvement from baseline (postoperative change of 8.6 vs.
Patients with worse preoperative mental health
not only demonstrated worse preoperative PROMIS
PF scores, but also continued to have significantly worse postoperative outcomes. However, the postoperative improvement experienced by patients was similar in the short-term following surgery regardless of preoperative mental health
status. Patients with poor mental health
experienced significantly less postoperative improvement only at the 1-year timepoint.
Level of Evidence: 3