Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: evaluation of the High quality Outcomes Database.
Neurosurg Focus. 2017 Aug;43(2):E11
Authors: Mummaneni PV, Bisson EF, Kerezoudis P, Glassman S, Foley Okay, Slotkin JR, Potts E, Shaffrey M, Shaffrey CI, Coric D, Knightly J, Park P, Fu KM, Devin CJ, Chotai S, Chan AK, Virk M, Asher AL, Bydon M
OBJECTIVE Lumbar spondylolisthesis is a degenerative situation that may be surgically handled with both open or minimally invasive decompression and instrumented fusion. Minimally invasive surgical procedure (MIS) approaches might shorten restoration, scale back blood loss, and decrease soft-tissue injury with resultant decreased postoperative ache and incapacity. METHODS The authors queried the nationwide, multicenter High quality Outcomes Database (QOD) registry for sufferers present process posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), together with Oswestry Incapacity Index (ODI), EQ-5D, numeric ranking scale (NRS)-back ache (NRS-BP), NRS-leg ache (NRS-LP), and satisfaction (North American Backbone Society satisfaction questionnaire). Multivariable regression fashions have been fitted for hospital size of keep (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A complete of 345 sufferers (open surgical procedure, n = 254; MIS, n = 91) from 11 taking part websites have been recognized within the QOD. The follow-up fee at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Total, baseline affected person demographics, comorbidities, and scientific traits have been equally distributed between the cohorts. 200 fifty seven sufferers underwent 1-level fusion (open surgical procedure, n = 181; MIS, n = 76), and 88 sufferers underwent 2-level fusion (open surgical procedure, n = 73; MIS, n = 15). Sufferers in each teams reported vital enchancment in all major outcomes (all p < zero.001). MIS was related to a considerably decrease imply intraoperative estimated blood loss and barely longer operative instances in each 1- and 2-level fusion subgroups. Though the LOS was shorter for MIS 1-level circumstances, this was not considerably totally different. No distinction was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical teams. Nevertheless, change in useful final result scores for sufferers present process 2-level fusion was notably bigger within the MIS cohort for ODI (-27 vs -16, p = zero.1), EQ-5D (zero.27 vs zero.15, p = zero.08), and NRS-BP (-Three.5 vs -2.7, p = zero.41); statistical significance was proven just for adjustments in NRS-LP scores (-Four.9 vs -2.eight, p = zero.02). On risk-adjusted evaluation for 1-level fusion, open versus minimally invasive strategy was not vital for 12-month PROs, LOS, and 90-day return to work. CONCLUSIONS Vital enchancment was discovered when it comes to all useful outcomes in sufferers present process open or MIS fusion for lumbar spondylolisthesis. No distinction was detected between the two strategies for 1-level fusion when it comes to patient-reported outcomes, LOS, and 90-day return to work. Nevertheless, sufferers present process 2-level MIS fusion reported considerably higher enchancment in NRS-LP at 12 months than sufferers present process 2-level open surgical procedure. Longer follow-up is required to offer additional perception into the comparative effectiveness of the two procedures.
PMID: 28760035 [PubMed – indexed for MEDLINE]