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Clinical Application of Microscope-Assisted Minimally Invasive Anterior Lumbar Interbody Fusion
Published on: June 16, 2023
592
Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study
Daniel Lewis1,2,3, Shivan Marya4, Roberto Carrasco5
1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Asian Spine Journal
|October 3, 2023
Summary
This study found no significant difference in clinical outcomes between open and minimally invasive lumbar fusion techniques at two years. Surgeon preference and training should guide surgical approach selection for lumbar fusion.
Area of Science:
- Spine surgery
- Orthopedics
- Neurosurgery
Background:
- Various surgical techniques exist for lumbar fusion, including open and minimally invasive approaches.
- Previous comparative studies have limitations due to heterogeneous data, complicating interpretation.
Purpose of the Study:
- To evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques.
- Compare outcomes between posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) (open and minimally invasive), and posterolateral fusion.
Main Methods:
- Retrospective analysis of 447 patients undergoing one/two-level lumbar fusion between 2011 and 2018.
- Core Outcomes Measure Index (COMI) questionnaires assessed patient-reported outcomes pre- and post-surgery (3 months, 1 year, 2 years).
- Statistical analysis included Pearson's chi-square, Kruskal-Wallis, mixed-effects models, and ordinal logistic regression.
Main Results:
- Postoperative COMI scores significantly improved across all procedures compared to pre-surgery (p<0.001).
- No significant difference in postoperative COMI scores was observed between techniques.
- Minimally invasive TLIF resulted in a shorter post-surgery hospital stay than open PLIF (p=0.03).
- Predictors of higher postoperative COMI scores included higher pretreatment COMI, previous surgery, younger age, higher BMI, lytic spondylolisthesis, and degenerative disc disease.
Conclusions:
- No significant difference in clinical outcomes between open and minimally invasive lumbar fusion techniques at 2-year follow-up.
- Findings suggest that surgeon preference and training are key factors in selecting the surgical approach for lumbar fusion.
