Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

Senker, Wolfgang; Gruber, Andreas; Gmeiner, Matthias; Stefanits, Harald; Sander, Kirsten; Rössler, Philipp; Pflugmacher, Robert

doi:10.1111/os.12397

Cited by 14 publications

(14 citation statements)

References 27 publications

(38 reference statements)

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“…A multicenter study found equivalent outcomes for obese patients having spinal MISS or open techniques [ 190 ]. Conversely, Senkar et al found minimally invasive surgical techniques had the highest utility in patients with multiple comorbidities [ 191 ].…”

Section: Discussionmentioning

confidence: 99%

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

et al. 2021

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Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Conclusions We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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Section: Discussionmentioning

confidence: 99%

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

et al. 2021

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“…A multicenter study found equivalent outcomes for obese patients having spinal MISS or open techniques (188). Conversely, Senkar et all found minimally invasive surgical techniques had the highest utility in patients with multiple comorbidities (189). There is evidence that minimally invasive surgical approaches improve pain scores, decrease opioid consumption and decrease length of stay, when used within the appropriate clinical context.…”

Section: Discussionmentioning

confidence: 99%

Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

Licina

Silvers

Laughlin

et al. 2020

Preprint

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Background Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on societal recommendations and qualitative reviews. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review. Methods We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined care components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). We searched the following databases (1990 onwards) MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. A narrative synthesis was provided. Where applicable, we constructed Evidence Profile (EP) tables for each individual element. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. Confidence in cumulative evidence for each component of the pathway was classified according to the GRADE system. Results We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We found specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables for 12/22 components. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components. Discussion We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

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“…Previous studies have reported that decreased bone graft volume decreases the mass, which consolidates into a thick bone mass and in turn fails to significantly increase the fusion mass (5,7,13). Conversely, increasing the bone graft volume has been demonstrated to induce extensive bone resorption, which in turn decreases the bone matrix for new bone construction, resulting in failure of spinal fusion (14). Thus, the bone graft volume and structural changes essentially determine the fusion rate success.…”

Section: Discussionmentioning

confidence: 99%

Quantification evaluation of structural autograft versus morcellized fragments autograft in patients who underwent single‑level lumbar laminectomy

Yang

Wang

He³

et al. 2020

Exp Ther Med

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Posterolateral fusion (PLIF) with autogenous bone graft is considered the gold standard for lumbar spinal fusion. However, the fusion rate and effectiveness of locally derived corticocancellous structural autograft vs. morcellized fragments autograft for lumbar PLIF, following single level lumbar laminectomy in patients with symptomatic lumbar spinal stenosis, remain unknown. Thus, the present study aimed to compare the fusion rates of corticocancellous structural autograft and morcellized fragments autograft for the treatment of lumbar PLIF. A randomized self-controlled trial was conducted comprising of 135 patients with symptomatic lumbar spinal stenosis, single level lumbar laminectomy and PLIF, with corticocancellous structural autograft (group 1) and morcellized fragments autograft (group 2). The primary outcome measurements included the PLIF rate, radio density and dimensions of PLIF mass on both sides, which were assessed via X-rays at 3, 6 and 12 months, postoperatively. Furthermore, changes in bilateral bone fusion bridges were assessed via CT scanning, according to the Lenke CT fusion measurement criteria. The follow-up period lasted for 1 year (period between January 2013 and January 2018). Of the 135 patients were initially included in the present study, 7 patients were lost during the following up process. Therefore, data from 128 patents were eventually assessed, 94.8% of surgical levels were observed at Honghui Hospital. According to the Lenke CT fusion measurement criteria, the overall unilateral fusion rates were 71.9% (92/128) in group 1 and 31.3% (40/128) in group 2. Furthermore, both the radio density and dimensions of PLIF mass significantly decreased at a faster rate in group 1 compared with group 2 (radio density; 0.65-0.49 vs. 0.63-0.61; P<0.05 and PLIF mass; 398-124 vs. 376-223 mm 2 ; P<0.05). The CT scan results demonstrated that the mean volume of bone graft was significantly greater in group 1 compared with group 2, at 12 months postoperatively (1.47 vs. 1 cm 3 ; P<0.05). Taken together, the results of the present study suggested that corticocancellous structural autograft is more effective for earlier resorption and stabilization of patients undergoing PLIF, compared with morcellized fragments autograft.

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Surgical and Clinical Results of Minimally Invasive Spinal Fusion Surgery in an Unselected Patient Cohort of a Spinal Care Unit

Abstract: Minimally invasive spinal surgery is a safe and effective treatment option and may be superior to open surgery in subpopulations with significant co-morbidities and risk factors, such as elderly and obese patients as well as patients with an active smoking status.

Cited by 14 publications

References 27 publications

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

Pathway for Enhanced Recovery after Spinal Surgery-A Systematic Review of Evidence for use of Individual Components

Quantification evaluation of structural autograft versus morcellized fragments autograft in patients who underwent single‑level lumbar laminectomy

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