Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study

Abstract

Background:Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus open TLIF, addressing lumbar degenerative disc disease (DDD) or grade I spondylolisthesis (DS), are associated with shorter hospital stays, decreased blood loss, quicker return to work, and equivalent short- and long-term outcomes. However, no prospective study has assessed whether the extent of intraoperative muscle trauma utilizing creatinine phosphokinase levels (CPK) differently impacts long-term outcomes.Methods:Twenty-one patients underwent MIS-TLIF (n = 14) versus open-TLIF (n = 7) for DDD or DS. Serum CPK levels were measured at baseline, and postoperatively (days 1, 7, and 1.5, 3 and 6 months). The correlation between the extent of intraoperative muscle trauma and two-year improvement in functional disability was evaluated (multivariate regression analysis). Additionally, baseline and two-year changes in Visual Analog Scale (VAS)-leg pain (LP), VAS-back pain (BP), Oswestry Disability Index (ODI), Short-Form-36 (SF-36) Physical Component Score (PCS) and SF-36 Mental Component Score (MCS), and postoperative satisfaction with surgical care were assessed.Results:Although the mean change from baseline in the serum creatine phosphokinase level on POD 1 was greater for MIS-TLIF (628.07) versus open-TLF (291.42), this did not correlate with lesser two-year improvement in functional disability. Both cohorts also showed similar two-year improvement in VAS-LP, ODI, and SF-36 PCS/MCS.Conclusion:Increased intraoperative muscle trauma unexpectedly observed in higher postoperative CPK levels for MIS-TLIF versus open-TLIF did not correlate with any differences in two-year improvement in pain and functional disability.

Comparison of the Clinical Effect of Simple Nucleotomy for the Treatment of Single-segment Lumbar Disc Herniation Using a Microscope and Percutaneous Transforaminal Endoscope

“…The increased value of the microscopic group was significantly higher than that of the percutaneous transforaminal endoscopic group, and the difference was statistically significant, which was essentially consistent with the previous research results. In addition, some scholars have found that the postoperative serum CPK content of male patients is much higher than that of females due to their higher muscle tissue content [18] ; however, in this study, there was no significant difference between the serum CPK content of males and females, whether before or after surgery. For patients with high risk of lumbar spine surgery, some scholars suggest taking dynamic and systematic measurements of CPK contents and establishing a standard measurement interval to assess the degree of muscle injury more effectively [19] .…”

Open versus minimally invasive TLIF: literature review and meta-analysis

“…of Pat.MeanSDNr. of Pat.Zhang et al 2017 [14]7.9± 2.84810.1± 3.259Tschugg et al 2017 [16]13.7± 51919.1± 1248Kulkarni et al 2016 [17]4.11± 1.8365.84± 2.24925Hey et al 2015 [18]10.0–257.7–25Terman et al 2014 [21]2–533–21Wong et al 2014 [22]2.75–1444.40–54Sulaiman et al 2014 [13]3.6± 1573.2± 0.211Singh et al 2014 [23]2.3± 1.2332.9± 1.133Gu et al 2014 [24]9.3± 3.74412.1± 3.638Brodano et al 2013 [25]4.1–307.4–34Seng et al 2013 [26]3.6± 0.3405.9± 0.440Cheng et al 2013 [27]4.8± 1.8506.05± 1.825Lau et al 2013 [28]3.1± 1.7784.7± 2.149Parker et al 2013 [30]3–504–50Adogwa et al 2012 [31]3–144–7Pelton et al 2012 [33]2± 0.713333± 1.133…”

“…of Pat.Preoperative (mean ± SD)Last follow-up (mean ± SD)Nr. of Pat.Preoperative (mean ± SD)Last follow-up (mean ± SD)Yang et al 2017 [15]2143.5 ± 15.112.0 ± 6.42044.2 ± 14.313.5 ± 6.5Adogwa et al 2015 [19]4050.18 ± 16.7438.57 ± 25.5210849.15 ± 15.2134.27 ± 22.07Terman et al 2014 [21]5359 (−)44 (−)2158 (−)45 (−)Wong et al 2014 [22]14452.8 (−)18 (−)5451.2 (−)21 (−)Sulaiman et al 2014 [13]5753.7 (−)26.4 (−)1157.8 (−)46.1 (−)Gu et al 2014 [24]4443.7 ± 4.316.5 ± 2.03844.3 ± 5.215.9 ± 1.9Brodano et al 2013 [25]3042 ± 6.210 ± 6.63446 ± 7.112 ± 5.8Seng et al 2013 [26]4041.3 ± 20.113.6 ± 2.84042.1 ± 16.312.3 ± 1.9Rodriguez-Vela et al 2013 [29]2128.85 ± 5.5212.09 ± 7.592027.19 ± 8.1918.10 ± 12.45Parker et al 2013 [30]5032.3 ± 6.711.0 ± 9.45034.3 ± 7.915.6 ± 10.3Adogwa et al 2012 [31]1420.50 ± 7.76–722.57 ± 9.3211.93 (−)Wang et al 2012 [32]4241.1 ± 10.318.2 ± 5.93940.217.4 ± 7.1Lee et al 2012 [6]7248.1 ± 18.821.4 ± 20.97244.4 ± 18.020.7 ± 16.5Parker et al 2012 [34]1536.9 ± 6.315.7 ± 8.91534.3 ± 11.517.1 ± 9.5…”

“…The complication rate with MITLIF is controversial when comparing MITLIF and OTLIF with heterogeneity seen among our included studies. Many studies showed no significant difference in the incidence of complications between the techniques [16, 19, 24, 26, 31, 48, 49]. Adogwa et al [19] conducted a prospective study examining 148 patients who underwent either MITLIF or OTLIF.…”

Comparison between Minimally Invasive Transforaminal Lumbar Interbody Fusion and Conventional Open Transforaminal Lumbar Interbody Fusion

“…[ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 ] All included studies were written in English or Chinese, and the full text was available. Ten studies were excluded because they included data from patients in previously published studies[ 37 38 39 40 41 42 43 44 45 46 ] and seven studies were removed because the included diseases did not fulfill the inclusion criteria. [ 47 48 49 50 51 52 53 ] One study had three subgroups, which were grouped by the number of surgery segments.…”