Practical answers to frequently asked questions in minimally invasive lumbar spine surgery

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Study Design. Retrospective review of prospectively collected data. Objective. To determine the Oswestry Disability Index (ODI) cutoff for achieving Patient Acceptable Symptom State (PASS) at one year following minimally invasive lumbar spine surgery. Summary of Background Data. An absolute score denoting PASS, rather than a change score denoting minimal clinically important difference (MCID), might be a better metric to assess clinical outcomes. Materials and Methods. Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The outcome measure was ODI. The anchor question was the Global Rating Change. "Compared with preoperative, you feel (1) much better, (2) slightly better, (3) same, (4) slightly worse, or (5) much worse." For analysis, it was collapsed to a dichotomous outcome variable (acceptable = response of 1 or 2, unacceptable = response of 3, 4, or 5). Proportion of patients achieving PASS and the ODI cutoff using receiver operating characteristic curve analyses were assessed for the overall cohort as well as subgroups based on age, sex, type of surgery, and preoperative ODI. Differences between the PASS and MCID metrics were analyzed. Results. A total of 137 patients were included. In all, 87% of patients achieved PASS. Patients less than or equal to 65 years and those undergoing fusion were more likely to achieve PASS. The receiver operating characteristic curve analysis revealed an ODI cutoff of 25.2 to achieve PASS (area under the curve. 0.872, sensitivity: 82%, specificity: 83%). The subgroup analyses based on age, sex, and preoperative ODI revealed area under the curve > 0.8 and ODI threshold values consistent between 25.2 and 25.5 (except 28.4 in patients with preoperative ODI > 40). PASS was found to have significantly higher sensitivity compared with MCID (82% vs. 69%, P = 0.01). Conclusions. Patients with ODI <25 are expected to achieve PASS, irrespective of age, sex, and preoperative disability. PASS was found to have significantly higher sensitivity than MCID.

Section: Discussionmentioning

confidence: 99%

ODI <25 Denotes Patient Acceptable Symptom State After Minimally Invasive Lumbar Spine Surgery

Shahi

Shinn

Singh

et al. 2022

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“…MCID achievement at less than six months and six months or above was assessed by analyzing the differences in preoperative postoperative PROM scores. The thresholds utilized for ODI, VAS-back, VAS-leg, and SF-12 PCS were 12.8, 1.2, 1.6, and 4.9, as previously described by Copay et al 25 PASS achievement was defined as an absolute postoperative ODI score of <25.2 at six months or above postoperatively, as previously reported by Shahi et al 26 Finally, patient improvement at less than six months and six months or above postoperatively was assessed via the responses on the GRC scale 27 : "Compared with preoperative, you feel (1) better, (2) same, or (3) worse? )".…”

Section: Data Collection and Outcome Measuresmentioning

confidence: 99%

Comparison of Robotics and Navigation for Clinical Outcomes After Minimally Invasive Lumbar Fusion

Shahi

Subramanian

Araghi

et al. 2023

Study Design. Retrospective cohort. Objective. To compare navigation and robotics in terms of clinical outcomes after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. Although robotics has been shown to have advantages like reduced radiation exposure, greater screw size, and slightly better accuracy over navigation, none of the studies has compared these two modalities in terms of clinical outcomes. Methods. Patients who underwent single-level MI-TLIF using robotics or navigation and had a minimum of 1-year follow-up were included. The robotics and navigation groups were compared for improvement in patient-reported outcome measures (PROMs), minimal clinically important difference, patient-acceptable symptom state, response on the global rating change scale, and screwrelated complication and reoperation rates. Results. A total of 278 patients (143 robotics, 135 navigation) were included. There was no significant difference between the robotics and navigation groups in the baseline demographics, operative variables, and preoperative PROMs. Both groups showed significant improvement in PROMs at below six and six months or above, with no significant difference in the magnitude of improvement between the two groups. Most patients achieved minimal clinically important difference and patient-acceptable symptom state and reported feeling better on the global rating change scale, with no significant difference in the proportions between the robotics and navigation groups. The screw-related complication and reoperation rates also showed no significant difference between the two groups. Conclusions. Robotics did not seem to lead to significantly better clinical outcomes compared with navigation following MI-TLIF. Although the clinical outcomes may be similar, robotics offers the advantages of reduced radiation exposure, greater screw size, and slightly better accuracy over navigation. These advantages should be considered when determining the utility and cost-effectiveness of robotics in spine surgery. Larger multicenter prospective studies are required in the future to further investigate this subject.

“…The surgical technique was performed as described in the literature. [31][32][33][34][35][36][37] In brief, it was performed through a tubular retractor under navigation or robotic guidance and involved unilateral facetectomy, disc space preparation, and insertion of an expandable cage.…”

Section: Minimally Invasive Transforaminal Lumbar Interbody Fusion Su...mentioning

confidence: 99%

Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion

Wetmore

Dalal

Shinn

et al. 2023

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Study Design. Matched cohort comparison.Objective. To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Summary of Background Data. There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF. Materials and Methods. Patients who underwent 1-level MI-TLIF and received the ESP block (group E) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups. Results. Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption (P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 (P = 0.016), and lower first pain scores postsurgery (P < 0.001). Group E had lower intraoperative opioid requirements (P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 (P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively (P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1. Conclusions. In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF.