Comparative Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review

Goldstein, Christina L.; Macwan, Kevin; Sundararajan, Kala; Rampersaud, Y. Raja

doi:10.1007/s11999-014-3465-5

Cited by 131 publications

(96 citation statements)

References 39 publications

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“…The exact methods used during our literature search have been described elsewhere. 15 Briefly, our research coordinator with training in systematic reviews performed an electronic search of Medline, EMBASE, Web of Science, and Cochrane databases from database inception to May 2012 using deri vatives of the following Medical Subject Headings (MeSH): "minimally invasive"/"minimal access" and "lumbar spine"/"lumbar vertebrae" or "fusion"/"surgical procedures." Only English-language citations were included.…”

Section: Systematic Review and Data Collectionmentioning

confidence: 99%

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Goldstein¹,

Macwan

Sundararajan

et al. 2016

SPI

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OBJECT The objective of this study was to determine the clinical comparative effectiveness and adverse event rates of posterior minimally invasive surgery (MIS) compared with open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). METHODS A systematic review of the Medline, EMBASE, PubMed, Web of Science, and Cochrane databases was performed. A hand search of reference lists was conducted. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) or comparative cohort studies including at least 10 patients undergoing MIS or open TLIF/PLIF for degenerative lumbar spinal disorders and reporting at least 1 of the following: clinical outcome measure, perioperative clinical or process measure, radiographic outcome, or adverse events. Study quality was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) protocol. When appropriate, a meta-analysis of outcomes data was conducted. RESULTS The systematic review and reference list search identified 3301 articles, with 26 meeting study inclusion criteria. All studies, including 1 RCT, were of low or very low quality. No significant difference regarding age, sex, surgical levels, or diagnosis was identified between the 2 cohorts (856 patients in the MIS cohort, 806 patients in the open cohort). The meta-analysis revealed changes in the perioperative outcomes of mean estimated blood loss, time to ambulation, and length of stay favoring an MIS approach by 260 ml (p < 0.00001), 3.5 days (p = 0.0006), and 2.9 days (p < 0.00001), respectively. Operative time was not significantly different between the surgical techniques (p = 0.78). There was no significant difference in surgical adverse events (p = 0.97), but MIS cases were significantly less likely to experience medical adverse events (risk ratio [MIS vs open] = 0.39, 95% confidence interval 0.23–0.69, p = 0.001). No difference in nonunion (p = 0.97) or reoperation rates (p = 0.97) was observed. Mean Oswestry Disability Index scores were slightly better in the patients undergoing MIS (n = 346) versus open TLIF/PLIF (n = 346) at a median follow-up time of 24 months (mean difference [MIS – open] = 3.32, p = 0.001). CONCLUSIONS The result of this quantitative systematic review of clinical comparative effectiveness research examining MIS versus open TLIF/PLIF for degenerative lumbar pathology suggests equipoise in patient-reported clinical outcomes. Furthermore, a meta-analysis of adverse event data suggests equivalent rates of surgical complications with lower rates of medical complications in patients undergoing minimally invasive TLIF/PLIF compared with open surgery. The quality of the current comparative evidence is low to very low, with significant inherent bias.

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Section: Systematic Review and Data Collectionmentioning

confidence: 99%

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Goldstein¹,

Macwan

Sundararajan

et al. 2016

SPI

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212

128

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“…For patients with spondylolisthesis refractory to conservative therapy, surgical intervention represent an alternative option with studies [1][2][3][4] Many studies have focused on comparing perioperative, functional and pain outcomes between MIS and OS in treating general lumbar degenerative diseases (including spondylolisthesis, disc disease and spinal stenosis). Systematic evidence has investigated MIS versus OS in this group of conditions for spinal fusion [6][7][8][9] , laminectomy 10,11 , discectomy 12 , and pedicle screw fixation 13 . However, to the best of our knowledge, no review of spondylolisthesis has analysed perioperative, functional and pain outcomes between MIS and OS.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Surgery Versus Open Surgery Spinal Fusion for Spondylolisthesis

Kerezoudis

Gilder

et al. 2017

Spine

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“…The advantages of transforaminal interventions over the classical posterior interbody fusion have been confirmed by a number of studies: low risks of damage to dura mater and the spinal roots, lower blood loss, better bone block formation [6,7]. However, some authors evidence the significant injury of paravertebral tissues and muscular-ligamentous apparatus resulting from such interventions and contributing to the formation of rough scar-adhesion changes accompanied by durable postoperative pain and reduced life quality [8][9][10][11].…”

Section: Facet Stabilization In Degenerative Diseases Of the Lumbosacmentioning

confidence: 95%

“…Interbody fusion has traditionally been performed via anterior, posterolateral and posterior access. a number of complications such as overload of posterior supporting elements and damage to neurovascular structures in anterior interbody stabilization as well as risks of durotomy and significant traction of neural structures in posterior fixation necessitated the search for new technological solutions [2,5,7]. The method of TLIF introduced in 1982 allowed reducing iatrogenic aggressiveness of access and development of intracanal scar-adhesion changes [20].…”

Section: Excellentmentioning

confidence: 99%

Treatment of Patients with Degenerative Diseases of the Lumbosacral Spine Using a Novel Technology of Facet Stabilization with Facet Wedge Implant

Калинин¹,

Okoneshnikova²,

Byvaltsev³

2017

Sovrem Tehnol Med

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Russian FederationTranspedicular fixation with interbody fusion widely used in management of degenerative diseases of the lumbosacral spine is associated with significant intraoperative aggression during surgery and postsurgical pain syndrome. To improve treatment results, a novel minimally invasive technology of facet fixation with Facet wedge implant in combination with transpedicular stabilization and interbody fusion has been introduced.The aim of the investigation was to evaluate the efficacy of facet fixation technology with Facet wedge implant in combination with transpedicular stabilization and interbody fusion in treatment of patients with degenerative diseases of the lumbosacral spine.Materials and Methods. The study involved 19 patients who underwent unilateral decompression with transforaminal lumbar interbody fusion, ipsilateral transpedicular stabilization and facet fixation on the contralateral side, according to clinical and instrumental indications. The minimum follow-up period of observation and complex evaluation of treatment results was 12 months.Results. when assessing pain syndrome by visual analogue scale and the degree of disability according to Oswestry disability index in the early postoperative period and in the long-term period, mostly good and excellent outcomes, statistically significantly better results were observed compared to the preoperative values. an interbody bone block was formed within 12 months in 89% (n=17) of patients, according to radiographic data.Conclusion. Decompression with a novel minimally invasive technology of combined dorsal fusion provides the possibility to significantly reduce pain, lower the degree of disability and implement efficient stabilization of the operated functional spinal segment in patients with degenerative diseases of the lumbosacral spine.Key words: stabilization of facet joints; transpedicular fixation; spinal canal decompression; lumbosacral spine; degenerative lesion of the intervertebral disc; TLIF.For contacts: Vadim a. Byvaltsev, e-mail: byval75vadim@yandex.ru Facet Stabilization in Degenerative Diseases of the Lumbosacral SpineMany degenerative diseases of the lumbosacral spine are the indication for performing interbody fusion [1,2]. Transpedicular fixation of interbody cages has been the gold standard in effective stabilization of vertebral motion segments after resection of posterior supporting elements for decompression of spinal canal structures [3, 4].The method of transforaminal lumbar interbody fusion (TLIF), first introduced by Harms and Rolinger in 1982 [5], has gained popularity in the last two decades. The advantages of transforaminal interventions over the classical posterior interbody fusion have been confirmed by a number of studies: low risks of damage to dura mater and the spinal roots, lower blood loss, better bone block formation [6,7]. However, some authors evidence the significant injury of paravertebral tissues and muscular-ligamentous apparatus resulting from such interventions and contributing to the formatio...

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Comparative Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review

Cited by 131 publications

References 39 publications

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review

Minimally Invasive Surgery Versus Open Surgery Spinal Fusion for Spondylolisthesis

Treatment of Patients with Degenerative Diseases of the Lumbosacral Spine Using a Novel Technology of Facet Stabilization with Facet Wedge Implant

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