General Session: MIS-2
Presented by: K.A. Tan - View Audio/Video Presentation (Members Only)
K.A. Tan(1), H.W.D. Hey(1), N. Kumar(1), A.Q.A. Teo(1), G.K.P. Liu(1), H.K. Wong(1)
(1) National University Health System, Orthopaedic Surgery, Singapore, Singapore
Purpose of the Study: Despite the many recognized benefits of minimally-invasive (MI) compared to open Transforaminal Lumbar Interbody Fusion (TLIF), both procedures have similar long-term outcomes. Patients' preference for Minimally-Invasive Surgeries (MIS) may be confounded by a lack of understanding of what these approaches entail. This study aims to identify the various factors which influence patients' choice between MIS and open TLIF. Describe the methods used: This is a cross-sectional study. All patients seen in the outpatient clinic over a 3-month period for whom TLIF procedures were indicated were subjected to a stepwise interviewing process, being asked to select between open and MIS approaches at each step. Data was statistically analysed with stratified subgroup analysis performed to identify key predictors of selection changes. Summarize the
Findings: Fifty-four patients with a mean age of 55.8 years participated in the study. Thirteen (24.1%) consistently selected a single approach whilst 31 (57.4%) changed their selection more than once during the interviewing process. Overall, 12 patients (22.2%) had a different decision from their initial choice and 15 patients (27.8%) could not decide. A large proportion of patients (65.0%) favored the open midline incision initially. This proportion dropped to 16.7% (p< 0.001) after mention of the term MIS. The proportion of patients favoring MIS dropped significantly following discussions regarding the pros and cons from 83.3% to 53.7% (p=0.002), as well as conversion/revision surgery from 50% to 35% (p=0.017). Radiation and cosmesis were identified as the two most important factors that influence patients' final decisions. Include statement of
Conclusions: The midline incision is cosmetically more appealing to patients, and the advantages of the MIS approach may not be weighed as important by the patient compared to the surgeon. Given their equivalent long-term outcomes, it is crucial that patients are adequately informed during preoperative counseling in order to achieve the best consensus decision.