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A Comparison of Surgical Outcomes Between Minimally Invasive and Open Thoracolumbar Corpectomy
Ehsan Tabaraee1, Junyoung Ahn1, Khaled Aboushaala1
1Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Background:
Minimally invasive (MIS) techniques have gained considerable attention for the management of degenerative spinal pathologies. However, few studies have compared the outcomes between MIS and open thoracolumbar corpectomies. The purpose of this study was to compare perioperative variables between MIS and open thoracolumbar corpectomy.
Methods:
Retrospective review of 33 patients who underwent either an MIS or open thoracolumbar corpectomy by a single surgeon between 2005 and 2012 was performed. Patients were separated into anterior-posterior MIS (MIS AP), anterior-posterior open (AP), and posterior open (P) cohorts. Postoperative narcotic use was converted to oral morphine equivalents (OMEs). Demographics, comorbidity, perioperative variables, complications, and computed tomographic analyses were assessed. Fisher exact test was performed for categorical variables and Student t test for continuous variables. A P value of ≤ .05 denoted statistical significance.
Results:
Thirty-three patients underwent an MIS AP, AP, or P thoracolumbar corpectomy (39.4% vs 15.2% vs 45.5%, respectively). MIS AP patients were younger with a lower comorbidity burden than either open cohorts. In addition, MIS AP patients demonstrated a decreased procedural time, lower blood loss, and shorter hospitalization than either open cohorts. MIS AP patients required less units of transfusion than P and AP patients while demonstrating lower postoperative narcotics consumption and reoperations rates than open AP patients. Surgical site infection rates, body mass index, intraoperative fluid requirements, and complication rates were similar between cohorts. All patients demonstrated successful arthrodesis at 1 year based upon computed tomography.
Conclusions:
MIS AP thoracolumbar corpectomy patients incurred decreased procedural times, shorter hospitalization, and lower blood loss compared with open patients. MIS AP patients demonstrated decreased postoperative narcotics consumption and reoperation rates compared with traditional AP patients. All patients demonstrated successful arthrodesis.
Clinical Relevance:
The MIS approach to thoracolumbar corpectomies appears to be a safe and efficacious alternative when compared with traditional methods.
Insights
Minimally invasive anterior-posterior (MIS AP) thoracolumbar corpectomy offers reduced procedural times, blood loss, and hospital stays compared to open surgery. This approach also lowers narcotic use and reoperation rates, proving effective for spinal pathologies.
Area of Science:
- Spine surgery
- Minimally invasive surgery
- Degenerative spinal pathologies
Background:
- Minimally invasive surgery (MIS) is increasingly used for spinal conditions.
- Limited comparative data exists between MIS and open thoracolumbar corpectomies.
- This study compares perioperative outcomes of MIS versus open thoracolumbar corpectomy.
Purpose of the Study:
- To compare perioperative variables between minimally invasive (MIS) and open thoracolumbar corpectomy.
- To evaluate the efficacy and safety of MIS AP thoracolumbar corpectomy against open approaches.
Main Methods:
- Retrospective review of 33 patients undergoing MIS AP, anterior-posterior open (AP), or posterior open (P) thoracolumbar corpectomy.
- Data collected included demographics, comorbidities, perioperative variables, complications, and CT analyses.
- Statistical analysis used Fisher exact test for categorical and Student t test for continuous variables.
Main Results:
- MIS AP patients were younger with lower comorbidity burden, shorter procedure times, less blood loss, and shorter hospital stays than open cohorts.
- MIS AP patients required fewer transfusions and had lower postoperative narcotic consumption and reoperation rates than AP patients.
- Similar rates of surgical site infection, BMI, intraoperative fluid use, and overall complications were observed across cohorts. All patients achieved successful arthrodesis at 1 year.
Conclusions:
- Minimally invasive anterior-posterior (MIS AP) thoracolumbar corpectomy demonstrates reduced procedural times, hospitalization, and blood loss compared to open techniques.
- MIS AP approach leads to decreased postoperative narcotic consumption and reoperation rates versus traditional anterior-posterior (AP) surgery.
- MIS AP thoracolumbar corpectomy is a safe and effective alternative for managing degenerative spinal pathologies.
