Nathaniel W. Jenkins, James M. Parrish, Benjamin C. Mayo, Nadia M. Hrynewycz, Thomas S. Brundage, Franchesca A. Mogilevsky, Joon S. Yoo, Kern Singh

June 2020, Volume 29, Issue 6, pp 1304 - 1310 Original Article Read Full Article 10.1007/s00586-020-06344-4

First Online: 19 February 2020

The identification of risk factors for increased postoperative pain following minimally invasive transforaminal lumbar interbody fusion


To evaluate specific demographic and perioperative variables associated with higher inpatient pain scores following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).


Patients who underwent a single-level, primary MIS TLIF were retrospectively reviewed. Perioperative outcomes were collected, and postoperative inpatient VAS pain scores were measured. Both bivariate and stepwise multivariate Poisson regressions with robust error variance were used to assess risk factors for average inpatient pain score ≥ 5.0. A final backward stepwise regression model was created using age, gender, smoking status, diabetes status, insurance status, BMI, comorbidity burden, pedicle screw laterality, operative time, and estimated blood loss.


A total of 255 patients undergoing primary, single-level MIS TLIF were included. Age less than 50 years, workers’ compensation insurance, preoperative VAS pain score ≥ 7, and operative duration ≥ 110 min were associated with greater postoperative pain. However, other variables such as gender, BMI, smoking status, comorbidity burden, diabetes status, and pedicle screw laterality were not associated with increased postoperative pain.


The results of this study suggest that younger age, workers’ compensation, elevated preoperative pain scores, and longer operative times are independently associated with greater inpatient pain following TLIF. Surgeons can use this information to better assess which patients may require additional pain control following TLIF. Patient expectations of postoperative outcomes in regard to pain and recovery may also be better managed.

Graphic abstract

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