152?Rate of Symptomatic Adjacent Segment Disease After Minimally Invasive vs Open Transforaminal Lumbar Interbody Fusion.
Neurosurgery. 2014 Aug;61 Suppl 1:210
Authors: Parker SL, Adamson TE, McGirt MJ, Deshmukh VR
INTRODUCTION:: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) allows for treatment of back and leg pain while minimizing adjacent tissue injury that could lead to adjacent segment degeneration. To date, no study has compared the rates of symptomatic adjacent segment disease following MIS vs open-TLIF.
METHODS:: One hundred sixty-one patients (86 MIS, 75 open) undergoing TLIF from 2004 to 2006 were entered into an institutional registry and prospectively followed for a minimum of 5 years postoperatively. Patient demographics, surgical variables, perioperative complications, time to return to work, need for revision surgeries, and postoperative health status were prospectively assessed.
RESULTS:: MIS and open-TLIF cohorts were similar in demographics, clinical presentation, and comorbidities. Perioperative complications including cerebrospinal fluid leak, surgical site infection, and return to operating room within 30 days were similar for both groups. MIS-TLIF was associated with a reduced length of stay (3.5 ± 1.5 days vs 5.9 ± 2.9 days, P < .001) and less blood loss (129 ± 80 cc vs 475 ± 299 cc, P < .001). MIS-TLIF patients had a decreased duration of postoperative narcotic dependence compared to those who underwent open-TLIF, Fig. 1. MIS-TLIF was associated with an improved ability to return to work (67.2% vs 42.6%, P = .009) and an attenuated time to return to work, Figure 2. At 5 years after surgery, patients undergoing MIS vs open-TLIF had a significantly reduced incidence of surgical intervention for symptomatic adjacent segment disease (9.3% vs 22.7%, P = .03).
CONCLUSION:: Symptomatic adjacent segment degeneration remains a significant long-term consequence following spinal fusion. MIS techniques to lumbar fusion avoid the extensive tissue dissection that can lead to adjacent-level instability. MIS TLIF showed a significant reduction in symptomatic adjacent segment disease requiring further operative intervention at 5-year follow-up. Also, MIS-TLIF is associated with reduced length of stay, decreased blood loss, reduced narcotic dependence, and an accelerated return to work compared to open-TLIF.
PMID: 25032603 [PubMed – as supplied by publisher]