General Session: MIS - Hall F
Presented by: C. Wade
Z. Bereczki(1), S. Prada(1), S. Songhusrt(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
Introduction: Traditionally, lumbar stenosis is treated with an open, decompressive laminectomy with or without facetectomies. This has been a successful treatment for improvement of clinical symptoms but may unintentionally lead to cases of iatrogenic spinal instability, which may result in follow on surgical intervention for stabilization . With patient safety and successful outcomes being paramount in today's healthcare environment, the impact of degenerative spine surgery on patients advancing in age is critical. The challenges in traditional surgical treatment pathways that disrupt the normal anatomical structures of the spine and potential long-term spinal instability are obvious across all patients; however patients with age related comorbidities present a unique challenge to spine surgeons. Recent research has suggested, "minimally invasive spine surgery" (MISS) may address the diseased structures but minimize disruption of the surrounding normal anatomic structures. The objective of this paper is to retrospectively examine prospective surgical outcomes, return to work, and self-reported pain outcomes at preoperative and 12- months postoperative among 1186 patients who underwent a MISS spine surgery for the treatment of LSS in an ambulatory surgery center, while specifically examining the differences between age groups. Methodology: Patient Demographics 1186 primary lumbar MISS patients that met inclusion and exclusion criteria were evaluated from April, 2012 to September, 2016. Patients were stratified by age from 19-90 years. The percentage breakdown of patients in the sample by age are as follows: 19-29: 3%; 30-39: 11%; 40-49: 19%; 50-59: 29%; 60-69: 24%; 70-79: 9%; 80+: 2%. The safety and efficacy of performing MISS across age stratifications were assessed comparing intraoperative and perioperative complications as well as surgical blood loss and duration of the surgical procedure were reported. Patient reported outcomes where measured via a Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Statistical
Methods: A student t-test comparing ODI and VAS was conducted to determine if there were any significant differences before and after surgery in level of pain and disability between age groups.
Results: A significant decrease in VAS (p < 0.001) and ODI scores (p < 0.001) between preoperative and postoperative was observed with a 2.5 point VAS change and a 18.5 point ODI change. The average EBL was 44.55 ml and the LOS averaged at 61.21 min. There were 5 reported Duraleak complications. However each of the Duraleaks were across patients age groups and not centralized within any specific age group. The average length of time to return to work for patients studied was 1.46 months from the time of their surgery. Of particular interest for this study was that there were no statistically significant differences in the VAS and ODI changes between age groups.
Conclusion: Results indicate that MISS for the treatment of LSS is associated with short operative times, low complication rates, reduced return to work times, and minimal average EBL. Results also indicate that patients who underwent MISS also reported less pain and disability postoperatively than preoperatively. Specifically these changes were consistent across age groups indicating the safety and efficacy of MISS procedures for the treatment of LSS regardless of advanced age.