Effect of Minimally Invasive Technique on Return to Work and Narcotic Use Following Transforaminal Lumbar Inter-body Fusion

Parker, Scott L.; Lerner, Jason; McGirt, Matthew J.

doi:10.1097/ncm.0b013e3182529c05

Cited by 51 publications

(48 citation statements)

References 35 publications

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“…Our study supports previously reported lower infection rates and intraoperative blood loss associated with MIS. 17,18,20,27,28,38 Combining traditional open deformity correction with MIS techniques is an alternative method of achieving the goals of deformity surgery. In our study the incidence of complications in the HYB group was between the rates for the MIS and OPEN subgroups.…”

Section: Discussionmentioning

confidence: 99%

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Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

130

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Object It is hypothesized that minimally invasive surgical techniques lead to fewer complications than open surgery for adult spinal deformity (ASD). The goal of this study was to analyze matched patient cohorts in an attempt to isolate the impact of approach on adverse events. Methods Two multicenter databases queried for patients with ASD treated via surgery and at least 1 year of follow-up revealed 280 patients who had undergone minimally invasive surgery (MIS) or a hybrid procedure (HYB; n = 85) or open surgery (OPEN; n = 195). These patients were divided into 3 separate groups based on the approach performed and were propensity matched for age, preoperative sagittal vertebral axis (SVA), number of levels fused posteriorly, and lumbar coronal Cobb angle (CCA) in an attempt to neutralize these patient variables and to make conclusions based on approach only. Inclusion criteria for both databases were similar, and inclusion criteria specific to this study consisted of an age > 45 years, CCA > 20°, 3 or more levels of fusion, and minimum of 1 year of follow-up. Patients in the OPEN group with a thoracic CCA > 75° were excluded to further ensure a more homogeneous patient population. Results In all, 60 matched patients were available for analysis (MIS = 20, HYB = 20, OPEN = 20). Blood loss was less in the MIS group than in the HYB and OPEN groups, but a significant difference was only found between the MIS and the OPEN group (669 vs 2322 ml, p = 0.001). The MIS and HYB groups had more fused interbody levels (4.5 and 4.1, respectively) than the OPEN group (1.6, p < 0.001). The OPEN group had less operative time than either the MIS or HYB group, but it was only statistically different from the HYB group (367 vs 665 minutes, p < 0.001). There was no significant difference in the duration of hospital stay among the groups. In patients with complete data, the overall complication rate was 45.5% (25 of 55). There was no significant difference in the total complication rate among the MIS, HYB, and OPEN groups (30%, 47%, and 63%, respectively; p = 0.147). No intraoperative complications were reported for the MIS group, 5.3% for the HYB group, and 25% for the OPEN group (p < 0.03). At least one postoperative complication occurred in 30%, 47%, and 50% (p = 0.40) of the MIS, HYB, and OPEN groups, respectively. One major complication occurred in 30%, 47%, and 63% (p = 0.147) of the MIS, HYB, and OPEN groups, respectively. All patients had significant improvement in both the Oswestry Disability Index (ODI) and visual analog scale scores after surgery (p < 0.001), although the MIS group did not have significant improvement in leg pain. The occurrence of complications had no impact on the ODI. Conclusions Results in this study suggest that the surgical approach may impact complications. The MIS group had significantly fewer intraoperative complications than did either the HYB or OPEN groups. If the goals of ASD surgery can be achieved, consideration should be given to less invasive techniques.

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Section: Discussionmentioning

confidence: 99%

“…17,18,20,24,27,28,36 Potential disadvantages may include limited sagittal correction. Complications of these increasingly applied procedures in the treatment of ASD must be examined, compared, and reported.…”

mentioning

confidence: 99%

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Uribe

Deukmedjian

Mummaneni³

et al. 2014

FOC

130

View full text Add to dashboard Cite

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“…13,20,32 These increased costs are mostly attributable to higher rates of complication, longer length of stay, more blood loss, and more postoperative services used compared with a minimally invasive approach. 3,13,19,[24][25][26]31 Additionally, studies have reported that a minimally invasive approach has been shown to be associated with faster narcotic independence, faster return to work after surgery, decreased pain, and decreased surgical time. 16,19,22,27 A review article by Parker et al found accelerated return to work and narcotic independence after minimally invasive TLIF compared with open TLIF.…”

Section: Discussionmentioning

confidence: 99%

“…3,13,19,[24][25][26]31 Additionally, studies have reported that a minimally invasive approach has been shown to be associated with faster narcotic independence, faster return to work after surgery, decreased pain, and decreased surgical time. 16,19,22,27 A review article by Parker et al found accelerated return to work and narcotic independence after minimally invasive TLIF compared with open TLIF. 19 However, few other 16 It is important to point out the larger cost difference associated with indirect costs in this study, which is greater than 3 times more than the savings in direct costs.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness analysis in minimally invasive spine surgery

Al-Khouja¹,

Baron²,

Johnson

et al. 2014

FOC

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Object Medical care has been evolving with the increased influence of a value-based health care system. As a result, more emphasis is being placed on ensuring cost-effectiveness and utility in the services provided to patients. This study looks at this development in respect to minimally invasive spine surgery (MISS) costs. Methods A literature review using PubMed, the Cost-Effectiveness Analysis (CEA) Registry, and the National Health Service Economic Evaluation Database (NHS EED) was performed. Papers were included in the study if they reported costs associated with minimally invasive spine surgery (MISS). If there was no mention of cost, CEA, cost-utility analysis (CUA), quality-adjusted life year (QALY), quality, or outcomes mentioned, then the article was excluded. Results Fourteen studies reporting costs associated with MISS in 12,425 patients (3675 undergoing minimally invasive procedures and 8750 undergoing open procedures) were identified through PubMed, the CEA Registry, and NHS EED. The percent cost difference between minimally invasive and open approaches ranged from 2.54% to 33.68%—all indicating cost saving with a minimally invasive surgical approach. Average length of stay (LOS) for minimally invasive surgery ranged from 0.93 days to 5.1 days compared with 1.53 days to 12 days for an open approach. All studies reporting EBL reported lower volume loss in an MISS approach (range 10–392.5 ml) than in an open approach (range 55–535.5 ml). Conclusions There are currently an insufficient number of studies published reporting the costs of MISS. Of the studies published, none have followed a standardized method of reporting and analyzing cost data. Preliminary findings analyzing the 14 studies showed both cost saving and better outcomes in MISS compared with an open approach. However, more Level I CEA/CUA studies including cost/QALY evaluations with specifics of the techniques utilized need to be reported in a standardized manner to make more accurate conclusions on the cost effectiveness of minimally invasive spine surgery.

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“…However, there is a tendency towards longer surgical time and greater exposure to radiation. 5,12,[15][16][17][18][19] …”

Section: Introductionmentioning

confidence: 99%

Tlif-Mis vs Tlif-Open: Cost Evaluation

et al. 2018

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Objective: To evaluate the direct costs of transforaminal lumbar interbody fusion (TLIF) and minimally invasive surgery (MIS) or open technique (OPEN). Methods: The present study is descriptive and retrospective. Sixteen patients with degenerative spinal pathology operated on with the TLIF MIS technique and TLIF OPEN were included over a 13-month period. Days of hospital stay, blood loss, surgical time, medical care and costs were compared. Results: The mean number of days of hospital stay was 6.7 ± 4.3 days with TLIF MIS and 11.1 ± 6.5 days with TLIF OPEN. The blood loss was 307 ± 81.6 ml (range 200-400 ml) with TLIF MIS and 803 ± 701.3 ml (range 200-1800 ml) with TLIF OPEN. The surgical time was 320 ± 92.6 minutes (range 210-500 minutes) in TLIF MIS and 372 ± 95.2 minutes (280-540 minutes) in TLIF OPEN. Conclusions: The difference in surgical costs and time between the two procedures was not statistically significant. There was less bleeding during the TLIF-MIS surgery, as well as a correlation between shorter days of hospital stay proportional to bleeding and surgical time, which translates into a reduction in the cost of these items. Level of Evidence III; Analysis based on alternatives and limited costs.Keywords: Intervertebral disc degeneration; Spinal fusion; Arthrodesis. de 6,7 ± 4,3 días con TLIF MIS y de 11,1 ± 6,5 días con TLIF OPEN. La pérdida sanguínea fue de 307 ± 81, con TLIF MIS y de 803 ± 701,3 ml (rango 200-1800 ml) RESUMO Objetivo: Garantir benefícios econômicos diretos de cada procedimento cirúrgico. Metodologia: apresentar um estudo descritivo e retrospectivo. Dezesseis pacientes com patologia degenerativa de colônias operados com a técnica TLIF MIS e TLIF OPEN foram incluídos durante um período de 13 meses. Foram comparados os dias de internação RESUMEN Objetivo: Evaluar los costos directos de la fusión intersomática lumbar transforaminal (TLIF) de mínima invasión (MIS) o técnica abierta (OPEN). Métodos: El presente estudio es descriptivo y retrospectivo. Se incluyeron 16 pacientes con patología degenerativa de columna intervenidos con la técnica TLIF MIS y TLIF OPEN en un período de 13 meses. Se compararon días de estancia hospitalaria, pérdida sanguínea, tiempo quirúrgico, atención médica y costos. Resultados: La media de días de estancia hospitalaria fue

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Effect of Minimally Invasive Technique on Return to Work and Narcotic Use Following Transforaminal Lumbar Inter-body Fusion

Cited by 51 publications

References 35 publications

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Complications in adult spinal deformity surgery: an analysis of minimally invasive, hybrid, and open surgical techniques

Cost-effectiveness analysis in minimally invasive spine surgery

Tlif-Mis vs Tlif-Open: Cost Evaluation

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