Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques?

Bortz, Cole; Alas, Haddy; Segreto, Frank A.; Horn, Samantha R.; Varlotta, Christopher; Brown, Avery; Pierce, Katherine E.; Ge, David H.; Vasquez-Montes, Dennis; Lafage, Virginie; Lafage, Renaud; Fischer, Charla R.; Gerling, Michael C.; Protopsaltis, Themistocles S.; Buckland, Aaron J.; Sciubba, Daniel M.; Ramos, Rafael De la Garza; Passias, Peter G.

doi:10.1177/2192568219867289

Cited by 6 publications

(7 citation statements)

References 25 publications

(46 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…With the advancements in spine field, including minimally invasive procedures numerous studies have compared outcomes and costs in primary and revision open and MIS surgeries 19–22. Our findings show that the MIS group trended towards higher rates of nervous system complications at 30-, 90-, and 180-day readmission and higher rates of infection and UTI within 30 days of the fusion.…”

Section: Discussionmentioning

confidence: 71%

Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion

Ballatori¹,

Shahrestani²,

Chen³

et al. 2021

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

The aim of this study was to compare the hospital charges and postoperative complications of minimally invasive surgery (MIS) and open approaches to sacroiliac joint (SIJ) fusion. Summary of Background Data:The data source utilized in this study is the Healthcare Cost and Utilization Project National Readmission Database (NRD) from 2016 and 2017. The NRD is a yearly nationally representative inpatient database from the Agency for Healthcare Research and Quality with information regarding patient demographics, diagnoses, procedures, and readmissions.Materials and Methods: The 2016−2017 NRD was used to identify 2521 patients receiving SIJ fusion with open (n = 1990) or MIS approaches (n = 531) for diagnosed sacrum pain, sacroiliitis, sacral instability, or spondylosis after excluding for those who received prior SIJ fusion, those diagnosed with neoplasms or trauma of the pelvis or sacrum, and nonelective procedures. We then one-to-one propensity-matched the open (n = 531) to the MIS approach (n = 531) for age, sex, and Charlson Comorbidity Index. Statistical analysis was performed to compare total hospital charges, immediate surgical complications, nonelective readmission rate, and 30-, 90-, and 180-day postoperative complications between the 2 approaches.Results: The mean total hospital charge was the only significant difference between 2 group. Open SIJ fusion had significantly higher charge compared with the MIS approach

show abstract

Section: Discussionmentioning

confidence: 71%

Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion

Ballatori¹,

Shahrestani²,

Chen³

et al. 2021

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

show abstract

“…Like the current study, invasiveness has also been correlated to increased rates of postoperative complications in ASD surgery. 25,34 A study analyzing the effect of invasiveness in ASD surgery by frailty correlated the likelihood of major complications and reoperations with increased invasiveness, along with the incidence not meeting a favorable outcome. 25 Upon logistic regression and CIT analysis, the authors further derived invasiveness thresholds for each frailty category, generating a threshold of 63.9 for their cohort overall.…”

Section: Discussionmentioning

confidence: 99%

“…Distal junctional failure (DJF), also termed severe DJK, was defined as a DJK angle > 20 degrees AND a change in the DJK angle > 20 degrees from baseline to 2 years OR DJK deemed "catastrophic" by a consensus of surgeons within the study group. 34…”

Section: Definition Of Outcomesmentioning

confidence: 99%

Patient-specific Cervical Deformity Corrections With Consideration of Associated Risk

Passias,

Pierce,

Williamson

et al. 2023

Clinical Spine Surgery: A Spine Publication

Self Cite

View full text Add to dashboard Cite

Study Design/Setting: This was a retrospective cohort study. Background: Little is known of the intersection between surgical invasiveness, cervical deformity (CD) severity, and frailty. Objective: The aim of this study was to investigate the outcomes of CD surgery by invasiveness, frailty status, and baseline magnitude of deformity. Methods: This study included CD patients with 1-year follow-up. Patients stratified in high deformity if severe in the following criteria: T1 slope minus cervical lordosis, McGregor’s slope, C2–C7, C2–T3, and C2 slope. Frailty scores categorized patients into not frail and frail. Patients are categorized by frailty and deformity (not frail/low deformity; not frail/high deformity; frail/low deformity; frail/high deformity). Logistic regression assessed increasing invasiveness and outcomes [distal junctional failure (DJF), reoperation]. Within frailty/deformity groups, decision tree analysis assessed thresholds for an invasiveness cutoff above which experiencing a reoperation, DJF or not achieving Good Clinical Outcome was more likely. Results: A total of 115 patients were included. Frailty/deformity groups: 27% not frail/low deformity, 27% not frail/high deformity, 23.5% frail/low deformity, and 22.5% frail/high deformity. Logistic regression analysis found increasing invasiveness and occurrence of DJF [odds ratio (OR): 1.03, 95% CI: 1.01–1.05, P=0.002], and invasiveness increased with deformity severity (P<0.05). Not frail/low deformity patients more often met Optimal Outcome with an invasiveness index <63 (OR: 27.2, 95% CI: 2.7–272.8, P=0.005). An invasiveness index <54 for the frail/low deformity group led to a higher likelihood of meeting the Optimal Outcome (OR: 9.6, 95% CI: 1.5–62.2, P=0.018). For the frail/high deformity group, patients with a score <63 had a higher likelihood of achieving Optimal Outcome (OR: 4.8, 95% CI: 1.1–25.8, P=0.033). There was no significant cutoff of invasiveness for the not frail/high deformity group. Conclusions: Our study correlated increased invasiveness in CD surgery to the risk of DJF, reoperation, and poor clinical success. The thresholds derived for deformity severity and frailty may enable surgeons to individualize the invasiveness of their procedures during surgical planning to account for the heightened risk of adverse events and minimize unfavorable outcomes.

show abstract

“…Previous studies have attributed such complications to prolonged retractor time (>30 minutes), increased tissue edema and damage from retractor placement, and excess extension of the psoas muscle opening leading to ischemic nerve damage [37,40]. Performing an open LLIF is especially not suitable, as these procedures are generally longer and patients require longer time to recover, often requiring hospitalization [41]. In our study, the attending surgeon benefitted from 15 years of experience with MIS techniques, allowing for shortened operative times, minimized blood loss, and tissue trauma burden.…”

Section: Complicationsmentioning

confidence: 99%

Lateral Lumbar Interbody Fusion in the Outpatient Setting with Multimodal Analgesic Protocol: Clinical Case Series

Jacob

Patel

Pawlowski

et al. 2022

J Minim Invasive Spine Surg Tech

View full text Add to dashboard Cite

Objective: Minimally invasive techniques and multimodal analgesia protocols have made spine surgery in the outpatient setting increasingly feasible. A number of spinal procedures have been documented in the outpatient setting, though the feasibility of lateral lumbar interbody fusion (LLIF) on an ambulatory basis has not been thoroughly assessed. To present a clinical case series of patients undergoing LLIF in the outpatient setting.Methods: A prospectively maintained surgical database was retrospectively reviewed to identify patients undergoing outpatient spine procedures with an enhanced multimodal analgesia protocol from October 2016 to February 2021. Patient demographics, medical and spinal diagnoses, procedural characteristics, operative duration, estimated blood loss (EBL), postoperative length of stay (LOS), postoperative pain scores, postoperative narcotic consumption, and incidence of any intra- or postoperative complications were collected. The state’s prescription monitoring program was queried to assess rates of filling narcotic prescriptions >6 weeks following surgery.Results: A total of 24 LLIF patients were included. Mean postoperative pain score was 5.8, and mean postoperative narcotic consumption was 26.8 oral morphine equivalents. All patients were discharged on the same day of surgery. No postoperative complications were observed. After the 6-week postoperative timepoint, 16.7% of patients filled a prescription for tramadol, 8.3% for hydrocodone, 4.2% for hydromorphone, 4.2% for cyclobenzaprine, and 4.2% for alprazolam. Conclusion: This clinical case series demonstrates that LLIF can be both safe and feasible in the outpatient setting, with minimal narcotic medication dependence in the postoperative period.

show abstract

Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques?

Cited by 6 publications

References 25 publications

Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion

Propensity-matched Analysis of 1062 Patients Following Minimally Invasive Versus Open Sacroiliac Joint Fusion

Patient-specific Cervical Deformity Corrections With Consideration of Associated Risk

Lateral Lumbar Interbody Fusion in the Outpatient Setting with Multimodal Analgesic Protocol: Clinical Case Series

Contact Info

Product

Resources

About