More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone
1Department of Winthrop NeuroScience, Winthrop University Hospital, Mineola, New York, USA.
Background:
In a recent study entitled: "More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review", Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability.
Methods:
In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13-0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion.
Results:
In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable.
Conclusions:
The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?
Insights
Minimally invasive lumbar surgery (MIS) leads to more nerve root injuries than open surgery. Surgeons should question the necessity of MIS procedures for conditions like degenerative disc disease.
Area of Science:
- Neurosurgery
- Spine Surgery
- Minimally Invasive Procedures
Background:
- A review by Epstein highlighted increased nerve root injuries with minimally invasive surgery (MIS) compared to open lumbar surgery.
- This includes procedures like diskectomy, decompression (laminectomy), and fusion for instability.
Purpose of the Study:
- To compare the incidence of nerve root injuries between minimally invasive lumbar surgery (MIS) and open conventional lumbar surgical techniques.
- To evaluate the necessity of MIS procedures for specific spinal conditions.
Main Methods:
- Analysis of large multicenter Spine Patient Outcomes Research Trial reviews.
- Comparison of nerve root injury rates across different open and MIS lumbar procedures (diskectomy, laminectomy, TLIF, PLIF, ALIF, XLIF).
Main Results:
- Open diskectomy had a 0.13-0.25% nerve root injury rate; laminectomy procedures had 0-2%.
- MIS procedures showed higher injury rates: TLIF (2%), PLIF (7.8%), ALIF (15.8%), and XLIF (23.8%).
- Nerve root injury rates were significantly higher with MIS techniques (TLIF, PLIF, ALIF, XLIF) compared to open surgery.
Conclusions:
- All evaluated MIS lumbar techniques resulted in more nerve root injuries than open conventional techniques.
- Many MIS procedures are performed for degenerative disc disease alone, raising questions about their necessity and indication.
- Spine surgeons should critically assess the rationale for offering MIS procedures, particularly for degenerative disc disease.
