Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Comparative Effectiveness and Cost-Utility Analysis

Parker, Scott L.; Mendenhall, Stephen K.; Shau, David N.; Zuckerman, Scott L.; Godil, Saniya S.; Cheng, Joseph; McGirt, Matthew J.

doi:10.1016/j.wneu.2013.01.041

Cited by 208 publications

(197 citation statements)

References 34 publications

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“…The improvement in VAS-BP, VAS-LP, and ODI scores closely resembles findings in the literature and was mostly sustained without significant changes during follow-up. 2,4,16,29,42 The only exception was a worsening of VAS-LP scores between 12 and 24 months (p = 0.026), although this worsening was found in another study as well. 15 We thought that this increase in leg pain could explain the increase in the use of analgesic medication over the same time span, but the two factors were not correlated (p = 0.78).…”

Section: Clinical Outcomesmentioning

confidence: 87%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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OBJECTIVEThe accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation.METHODSA retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures.RESULTSSeventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p < 0.001, OR 9.7). Additionally, a higher incidence of revision surgery for screw malposition was observed for freehand procedures than for the robot-guided procedures (p < 0.001, OR 8.1). The VAS score for back pain improved significantly from 66.9 ± 25.0 preoperatively to 30.1 ± 26.8 at the final follow-up, as did the VAS score for leg pain (from 70.6 ± 22.8 to 24.3 ± 28.3) and ODI (from 43.4 ± 18.3 to 16.2 ± 16.7; all p < 0.001). Undergoing PLIF, a high body mass index, smoking status, and a preoperative ability to work were identified as predictors of a reduction in back pain. Length of hospital stay was 2.4 ± 1.1 days and operating time was 161 ± 50 minutes. Ability to work increased from 38.9% to 78.2% of patients (p < 0.001) at the final follow-up, and 89.1% of patients indicated they would choose to undergo the same treatment again.CONCLUSIONSIn adults with low-grade spondylolisthesis, the data demonstrated a benefit in using robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other techniques.

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Section: Clinical Outcomesmentioning

confidence: 87%

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Schröder

Staartjes

2017

Neurosurgical Focus

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“…13,15 We did not observe a difference with regard to postoperative recovery; patients in both cohorts spent approximately 3-4 days in the hospital, which may attributed to the lower LOS in the open group than that reported in previous studies. 2,3,5,9,19,20 Finally, the rates for observed readmission and return to the operating room were very low in both groups; the second largest study to date by Parker and colleagues investigated 100 patients (50 in each arm) who underwent transforaminal interbody fusion (TLIF) for spondylolisthesis. 19 The authors found similar surgical morbidity and hospital readmission rates for MIS and open TLIF.…”

Section: Discussionmentioning

confidence: 99%

“…2,9,10,13,19,20,[22][23][24] Moreover, these studies are limited by their single-institution nature, thereby reflecting the experience of relatively few (1)(2)(3)(4) surgeons. In light of the limitations in the current literature, we conducted a retrospective analysis of prospectively collected data in a multiinstitutional spine registry that represents a real-world spinal practice comprising academic and private institutions.…”

mentioning

confidence: 99%

Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database

Mummaneni

Bisson

Kerezoudis

et al. 2017

Neurosurgical Focus

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OBJECTIVELumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability.METHODSThe authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)–back pain (NRS-BP), NRS–leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables.RESULTSA total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p < 0.001). MIS was associated with a significantly lower mean intraoperative estimated blood loss and slightly longer operative times in both 1- and 2-level fusion subgroups. Although the LOS was shorter for MIS 1-level cases, this was not significantly different. No difference was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (−27 vs −16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (−3.5 vs −2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (−4.9 vs −2.8, p = 0.02). On risk-adjusted analysis for 1-level fusion, open versus minimally invasive approach was not significant for 12-month PROs, LOS, and 90-day return to work.CONCLUSIONSSignificant improvement was found in terms of all functional outcomes in patients undergoing open or MIS fusion for lumbar spondylolisthesis. No difference was detected between the 2 techniques for 1-level fusion in terms of patient-reported outcomes, LOS, and 90-day return to work. However, patients undergoing 2-level MIS fusion reported significantly better improvement in NRS-LP at 12 months than patients undergoing 2-level open surgery. Longer follow-up is needed to provide further insight into the comparative effectiveness of the 2 procedures.

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“…In a few of these studies, the authors reported either equal or higher procedural cost with a minimally invasive approach, but this initial cost difference was offset by increased postoperative costs for the open procedure. 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.…”

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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Minimally Invasive versus Open Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Comparative Effectiveness and Cost-Utility Analysis

Cited by 208 publications

References 34 publications

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis

Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database

Cost-effectiveness analysis in minimally invasive spine surgery

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