Oral Posters: Values and Outcomes in Spine Surgery

Presented by: C. Wade - View Audio/Video Presentation (Members Only)

Author(s):

M. Flood(1), J. Weber(1), M. Weiss(1), C. Wade(2), R. Davis(1)

(1) Laser Spine Institute, Tampa, FL, United States
(2) Auburn University, Industrial and Systems Engineering, Auburn, AL, United States

Abstract

Transforaminal lumbar interbody fusion (TLIF) is one of the surgical options used for the stabilization and treatment of degenerative lumbar diseases, such as disc degeneration and spondylolisthesis, which have failed conservative management. Minimally invasive approaches to the lumbar spine continue to gain in popularity due to a reduction in approach-related morbidity compared to the traditional midline open techniques. The surgical management of spondylolisthesis requires decompression and stabilization. The minimally invasive TLIF technique is common practice for this pathology. MIS-TLIF offers potential advantages of reduced trauma to paraspinal muscles, minimized perioperative blood loss, quicker recovery and reduced risk of infection at surgical sites [1]. There is still a lack of comprehensive clinical evidence for the safety and efficacy of MIS-TLIF compared with conventional O-TLIF. Previous research has evaluated the safety and complications of MIS-TLIF compared to O-TLIF [2]. However, these previous studies comprise small sample sizes, as well as analysis of varying patient populations. Therefore, the purpose of our study was to evaluate the safety and efficacy of performing an MIS-TLIF in a large cohort of patients.

Methods: Over a 1-year period from December 2013 to January 2015, 200 patients were retrospectively evaluated. Clinical parameters, such as surgical blood loss and duration of the surgical procedure were reported. Patient-reported outcomes were measured via a Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) preoperatively and postoperatively at 12 months. Demographic data: A total of 200 patients underwent MIS-TLIF surgery planned as an outpatient procedure. An extensive preoperative clinical examination was performed to evaluate motor, sensory and reflex deficits. Radiological examination consisting of lumbar spine MRI, CT and plain X-rays with flexion and extension views were performed to confirm clinical diagnoses. Overall, 100% of patients were discharged less than 6 hours post surgeries. There was 1 reported intraoperative dura leak complication. The average length of surgery was 136 minutes with an average estimated blood loss of 149.05 mL.

Results: There was a significant reduction in both the ODI and VAS reported outcomes from pre to post-surgery. Results show a 48% improvement in the VAS and a 44% improvement in the ODI.

Conclusion: Outpatient surgery is an important means of reducing total surgery cost and patient morbidity. The findings of the current study indicate that an MIS-TLIF performed in an outpatient setting may prove to be beneficial in decreasing the complications and morbidity of standard treatments with lumbar spinal stenosis. Although any patient can experience a variety of complications from surgery, our analysis provides evidence that MIS-TLIF procedures in an outpatient setting result in fewer complications and improved patient outcomes regardless of patient demographics.

References: [1]. Wang MY, Cummock MD, Yu Y, Trivedi RA (2010) An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion. J Neurosurg Spine 12:694-699. doi:10.3171/2009.12. spine09621 [2]. Tian NF, Wu YS, Zhang XL, Xu HZ, Chi YL, Mao FM (2013) Minimally invasive versus open transforaminal lumbar interbody fusion: a meta-analysis based on the current evidence. Eur Spine J 22:1741-1749.