Association of Preoperative Cognitive Impairment with Poor Outcomes following Transforaminal Lumbar Spinal Fusion Surgery

Background: Preoperative cognitive function (PCF) is gaining attention as a predictor of surgical outcomes due to its association with muscle function and recovery. Its role in postoperative recovery following transforaminal lumbar interbody fusion (TLIF), however, remains unclear. Objectives: This study aimed to evaluate the impact of PCF on functional and quality-of-life outcomes after TLIF surgery. Materials and Methods: A prospective study of 89 patients undergoing TLIF assessed PCF preoperatively using the Short Portable Mental Status Questionnaire. Outcomes, including Japanese Orthopaedic Association (JOA) and EuroQol 5-Dimensions 3-Level (EQ-5D-3L) scores, were measured at baseline, 3, 6, and 12 months postsurgery. Generalized estimating equations analyzed the associations between PCF and recovery. Results: JOA and EQ-5D-3L scores improved significantly at all postoperative time points, reflecting enhanced functional and quality-of-life outcomes after TLIF. PCF showed a weak-to-moderate negative correlation with JOA and EQ-5D-3L scores across all time points. Greater PCF impairment was associated with lower postoperative JOA (β = −1.432, P = 0.036) and EQ-5D-3L (β = −0.065, P = 0.016) scores. Conclusions: PCF significantly affects postoperative outcomes following TLIF, particularly in early recovery. Assessing and addressing PCF preoperatively could enhance recovery trajectories.