232 - Comparing the Outcomes of Minimally Invasive Transfacet Lumbar Interbo...

#232 Comparing the Outcomes of Minimally Invasive Transfacet Lumbar Interbody Fusion for Multi-segment versus Single Segment Fusions

MIS Techniques and Outcomes

Poster Presented by: A.M. Jackson

Author(s):

A.M. Jackson (1)

(1) Michigan Neurosurgical Institute, Grand Blanc, MI, United States

Abstract

Background: Minimally invasive approaches to the lumbar spine allow for pedicle screw fixation and interbody fusion through a muscle splitting approach. This technique reduces the approach related morbidity of conventional open surgery. The aim of this study was to evaluate the outcome of patients who underwent this minimally invasive procedure.

Purpose: To evaluate the outcomes of patients who underwent a multi-level versus single level minimally invasive TLIF fusion procedure by a single surgeon.

Study Design: Retrospective case series.

Patient Sample: Patients who underwent minimally invasive pedicle screw fixation and interbody fusion by a single surgeon between May 2005 through June 2011.

Methods: Clinical outcome was assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI) and Short Form Health Survey-36 (SF-36). Primary end points analyzed include: postoperative neurologic status, operative time, blood loss, number of levels operated per surgery, postoperative pain, length of hospital stay, changes in analgesic requirements, and operative complications.

Results: 56 consecutive patients (288 pedicle screws, 72 interbody cages) met the study criteria and were included in this study. 41 single level cases and 15 multilevel fusions were evaluated.The mean follow up was 12 months. Blood loss for single level TLIF (mean 186.6 ml, sd 136.1) was significantly lower than for multi-level TLIF (mean 273.2, sd 186.6). Length of stay was similar in the single level group (mean 1.56 days, sd .87) and multi-level group (mean 1.35 days, sd 0.63). The operative time for single level (mean 200.0 minutes, sd 90.7) tended to be shorter then multi-level (mean 254.6, sd 98.4).Analgesic requirement decreased significantly by 12 months post operative visit. 7 patients developed postoperative complications: 4 patients required revision of mal-positioned screw, 2 patients required cage revision, and 1 patient with radicular stenosis. There were no infections.

Conclusions: We observed that Minimally Invasive Transfacet Lumbar Interbody Fusion is a safe and effective treatment option for lumbar instability and degenerative disc disease. Complications are higher in patients who have multiple spine disorders. Multi-level fusion patients were found to have shorter hospital stay. Single level fusion patients were found to have less blood loss. Minimally Invasive TLIF has a short length of stay with an early return to daily activities, even in multi-level fusion patients. It was difficult to consistently obtain outcomes study results on follow up patients. Observed statistically significant improvement in Oswestry and VAS scores.Minimally invasive approaches to the lumbar spine allow for pedicle screw fixation and interbody fusion through a muscle splitting approach. This technique reduces the approach related morbidity of conventional open surgery. The aim of this study was to evaluate the outcome of patients who underwent this minimally invasive procedure.