Minimally Invasive Versus Open Surgery for Degenerative Spine Disorders for Elderly Patients: Experiences from a Single Institution

Yolcu, Yagiz U.; Helal, Ahmed; Alexander, A. Yohan; Bhatti, Atiq ur Rehman; Alvi, Mohammed Ali; Abode-Iyamah, Kingsley; Bydon, Mohamad

doi:10.1016/j.wneu.2020.11.145

Cited by 16 publications

(9 citation statements)

References 30 publications

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“…[1] Due to the revolution of spinal endoscopic technology and the improvement of instruments, full endoscopic lumbar interbody fusion(ELIF) process has gradually established [2][3][4]. With the purpose of reducing surgical trauma and accelerating recovery, invasion of normal tissue and bleeding in open surgery [5] can be carefully controlled in endoscopic approach. Since SEHAT et al [6]proved the existence of perioperative hidden blood loss(HBL), this concept has been gradually accepted by surgeons.…”

Section: Introductionmentioning

confidence: 99%

Hidden blood loss and its possible risk factors in full endoscopic lumbar interbody fusion

Zhao

et al. 2022

Preprint

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Objective Full endoscopic lumbar interbody fusion (ELIF) is a representative recent emerging minimally invasive operation, and its effectiveness has been continuously proved. This study aimed to evaluate the hidden blood loss in ELIF procedure and its possible risk factors. Methods The blood loss was calculated by Gross formula. Sex, age, BMI, hypertension, diabetes, ASA classification, fusion levels, surgical approach type(the count of trans-Kambin approach and interlaminar approach), surgery time, preoperative RBC, HGB, Hct, PT, INR, APTT, Fg, postoperative mean arterial pressure, postoperative heart rate, Intraoperative blood loss (IBL), patient blood volume were included to investigate the possible risk factors by correlation analysis and multiple linear regression between variables and hidden blood loss. Results 96 patients (23 males, 73 females) who underwent ELIF were retrospective analyzed in this study. The total blood loss was 303.56 (120.49, 518.43) ml(median [interquartile range]), of which the hidden blood loss was 240.11 (65.51, 460.31) ml, accounting for 79.10% of the total blood loss. Multiple linear regression analysis indicated that fusion levels(P = 0.002), age(P = 0.003), hypertension(P = 0.000), IBL(P = 0.012), PT(P = 0.016), preoperative HBG(P = 0.037) were the possible risk factor for HBL. Conclusion The fusion levels, younger age, hypertension, PT, preoperative HBG are possible independent risk factor of HBL during ELIF procedure. In clinic, we should pay attention to the possibility of large perioperative blood loss even in minimally invasive surgery.

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Section: Introductionmentioning

confidence: 99%

Hidden blood loss and its possible risk factors in full endoscopic lumbar interbody fusion

Zhao

et al. 2022

Preprint

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“…The minuscule complication rate observed in the present cohort supports the trend in literature towards safe, minimally invasive, approaches to lumbar spine surgery. 10,35 While most patients rapidly recover from single-level lumbar decompression, there are certainly a group of patients with a complicated postoperative course warranting attention in the preoperative setting. The early identification of patients at high risk for delayed recovery is critical for the implementation of targeted interventions such as "enhanced recovery after surgery. "…”

Section: Discussionmentioning

confidence: 99%

Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model

et al. 2023

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Objective: The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.Methods: Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.Results: Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88).Conclusion: After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.

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“…The surgical plan should also depend on the patient's comorbid conditions and bone quality. For frail elderly individuals comorbid with cardiovascular and cerebrovascular diseases, diabetes, and severe osteopetrosis, MIS can promote rapid recovery after surgery (47,48). In contrast to conventional open procedures, endoscopic spine surgery does not require extensive soft-tissue stripping, resulting in minimal occurrence of postoperative muscle impingement (49).…”

Section: Feasibility Of Endoscopic Surgery For Dasmmentioning

confidence: 99%

Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature

Yang¹,

Rao²,

Liu³

et al. 2022

Ann Transl Med

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Background: Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses.

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Minimally Invasive Versus Open Surgery for Degenerative Spine Disorders for Elderly Patients: Experiences from a Single Institution

Cited by 16 publications

References 30 publications

Hidden blood loss and its possible risk factors in full endoscopic lumbar interbody fusion

Hidden blood loss and its possible risk factors in full endoscopic lumbar interbody fusion

Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model

Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature

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