Comparison of the Minimally Invasive and Conventional Open Surgery Approach in the Treatment of Lumbar Stenosis: A Systematic Review and a Meta-Analysis

Abstract

Introduction: Minimally invasive surgery (MIS) is increasingly used in the treatment of lumbar stenosis. However, it is still not clear if the employment of minimally invasive surgical techniques can achieve superior clinical outcomes compared to standard open laminectomy. Materials and Methods: An extensive literature review regarding the clinical outcome, safety, and efficiency of MIS and standard open surgery (OS) in the treatment of lumbar stenosis was conducted on Medline, Cochrane, EMBASE, and Google Scholar databases up to 19 August 2016. Results: Sixteen studies that enrolled a total of 1580 patients with surgically-indicated lumbar stenosis were identified; 793 patients underwent MIS and 787 patients underwent conventional OS. No significant difference was found in the improvement of Oswestry Disability Index (ODI) (P = 0.718) and operation time (P = 0.322) between patients from different treatment groups. MIS was associated with better visual analogue scale (VAS) for back pain (P = 0.01), shorter length of hospital stay (P <0.001), and lower blood loss (P <0.001). Conclusion: Our findings indicate that both MIS and standard OS can effectively manage patients with lumbar stenosis and lead to comparable clinical outcomes. Further studies are necessary to evaluate MIS with different types of conventional surgery for lumbar stenosis. Key words: Back pain, Laminectomy

Minimally Invasive Transpedicular Screw Fixation: Review of 152 Cases in a Single Institution. Steep or Shallow Learning Curve?

“…Chang et al also found no significant difference in ODI and operation time between MIS and conventional open surgery. 14 Wang et al, 15 however, found a significantly shorter operating time for MI-TLIF (127 ± 25 minutes) compared with open TLIF (168 ± 37 minutes) in obese patients. Concerning radiation exposure, most of the studies have shown significantly longer radiation exposure times during MISS surgery (range: 45.3–106 seconds) compared to conventional open procedures (range: 24–39 seconds).…”

Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis

“…However, there is no doubt about its minimally invasive nature. In the treatment of degenerative lumbar spine disease, the currently accepted clinical goals are minimal trauma, optimal neurological decompression and maximum preservation of the lumbar segmental motion [ 53 ]. In this context, PES is gradually gaining acceptance among clinicians and expanding the scope of its clinical use.…”

Compare of outcomes of minimally invasive and open surgical techniques in patients with symptomatic lumbar spine stenosis on the background of scoliotic deformity

“…Сравнение результатов микроэндоскопической декомпрессии у пациентов с симптоматическим стенозом и сопутствующей умеренной деформацией поясничного отдела позвоночника с данными о естественном прогрессировании деформации позволяет сделать вывод об отсутствии отрицательного влияния локальной декомпрессии на прогрессирование деформации [5]. Это выглядит логичным, учитывая основную мотивацию применения минимально инвазивных технологий в виде сохранения мышечного каркаса и задних элементов позвоночного столба, включая дугу, межостистые отростки и связочный аппарат [9][10][11]23]. Сохранение целостности этих структур позволяет предотвратить развитие ятрогенной послеоперационной нестабильности [24].…”

“…В настоящее время большое распространение в лечении СПС получили минимально инвазивные технологии, которые обладают рядом преимуществ в виде ограниченного повреждения мягких тканей, низкой кровопотери, менее выраженного послеоперационного болевого синдрома, сокращения сроков госпитализации, непродолжительного восстановительного периода [9][10][11]. Ряд авторов [5,8,12] указывают также на предпочтительность использования минимально инвазивных вмешательств при сочетании СПС и деформации позвоночника.…”