Lower complication and reoperation rates for laminectomy rather than MI TLIF/other fusions for degenerative lumbar disease/spondylolisthesis: A review

Abstract

Background:Utilizing the spine literature, we compared the complication and reoperation rates for laminectomy alone vs. instrumented fusions including minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) for the surgical management of multilevel degenerative lumbar disease with/without degenerative spondylolisthesis (DS).Methods:Epstein compared complication and reoperation rates over 2 years for 137 patients undergoing laminectomy alone undergoing 2-3 level (58 patients) and 4-6 level (79 patients) Procedures for lumbar stenosis with/without DS. Results showed no new postoperative neurological deficits, no infections, no surgery for adjacent segment disease (ASD), 4 patients (2.9%) who developed intraoperative cerebrospinal fluid (CSF) fistulas, no readmissions, and just 1 reopereation for a (postoperative day 7). These rates were compared to other literature for lumbar laminectomies vs. fusions (e.g. particularly MI TLIF) addressing pathology comparable to that listed above.Results:Some studies in the literature revealed an average 4.8% complication rate for laminectomy alone vs. 8.3% for decompressions/fusion; at 5 postoperative years, reoperation rates were 10.6% vs. 18.4%, respectively. Specifically, the MI TLIF literature complication rates ranged from 7.7% to 23.0% and included up to an 8.3% incidence of wound infections, 6.1% durotomies, 9.7% permanent neurological deficits, and 20.2% incidence of new sensory deficits. Reoperation rates (1.6–6%) for MI TLIF addressed instrumentation failure (2.3%), cage migration (1.26–2.4%), cage extrusions (0.8%), and misplaced screws (1.6%). The learning curve (e.g. number of cases required by a surgeon to become proficient) for MI TLIF was the first 33-44 cases. Furthermore, hospital costs for lumbar fusions were 2.6 fold greater than those for laminectomy alone, with overall neurosurgeon reimbursement quoted in one study as high as $142,075 per year.Conclusions:The spinal literature revealed lower complication and reoperation rates for lumbar laminectomy alone vs. higher rates for instrumented fusion, including MI TLIF, for degenerative lumbar disease with/without DS.

Comparison of Reoperation after Fusion and after Decompression for Degenerative Lumbar Spinal Stenosis: A Single-Center Experience of 987 Cases

“…13,14 Minimally invasive techniques in fusion surgery, such as the paraspinal transforaminal LIFn, have developed, and contribute to the low complication rates observed in our study. 15,16 These techniques reduce rates of dural puncture and muscle injury. Another advantage of fusion is immobilization and wide decompression (including exiting and traversing the nerve root), which reduces back pain and postoperative instability at the final follow-up, thereby improving patient satisfaction.…”

Preoperative measures to prevent/minimize risk of surgical site infection in spinal surgery

“…Postoperative spinal infections/SSI were typically dependent on the following variables; severity of disease, number of levels involved, presence/duration of postoperative drains used, prior hospitalization, duration of preoperative/postoperative stay, duration of surgery, number of transfusions, and number of surgeons. [1101115313337] In Shillingford et al ., the rate of SSI after scoliosis surgery (Scoliosis Research Society Morbidity/Mortality database) ranged from 1.9% to 4.4%. [37] Out of 47,755 procedures from 2012, 578 (1.2%) had SSIs.…”

“…In 2018, Epstein (2018) evaluated 137 patients undergoing 2–3 level (58 patients) and 4–6 level (79 patients) laminectomies for disk disease, multilevel stenosis, and/or degenerative spondylolisthesis (26/79 in the latter group). [15] There were no infections (no SSI) and lower complication/reoperation rates when compared to the literature on transforaminal lumbar interbody fusions (TLIF) (open/minimally invasive [MI]). In Epstein's series, at 2 postoperative years, there were no new postoperative neurological deficits, no infections, no reoperation for adjacent segment disease, four (2.9%) instances of intraoperative cerebrospinal fluid fistulas (e.g.…”

“…We have trialed a more prolonged preoperative protocol using CHG 4% for 2 weeks before spine surgery; in our recent series of 137 patients undergoing laminectomies alone, there were no reported infections. [15]…”

Unilateral Tubular Approach for Bilateral Laminotomy vs Transforaminal Lumbar Interbody Fusion for Lumbar Spinal Stenosis

“…Absence of muscle dissection with the endoscope and instruments over the lamina and preservation of the soft tissue structures, could alleviate the muscle atrophy and spinal instability 15 . Furthermore, another advantage of ULBD lies in its mitigation the risk of adjacent segment fusions postoperative, while adjacent segment disease following fusion involves fusing a second level in traditional revision surgery 16 .Also, the reduction in duration of hospitalization was observed.The complication rates in the literature for TLIF have an average of 36,7%, whereas minimally invasive laminectomy approaches have 28,4% 17 . The present study found that patients underwent PEID approach show good clinical outcomes and pain scores at 3 and 12 months after operation.…”