Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion

Rodríguez-Vela, Javier; Lobo-Escolar, Antonio; Joven-Aliaga, E.; Herrera, Antonio; Vicente, Julio; Suñén, E.; Loste, A.; Tabuenca, A. Aldana

doi:10.1007/s00586-009-1010-0

Cited by 60 publications

(33 citation statements)

References 47 publications

(90 reference statements)

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“…Percutaneous transpedicular screws are currently used in the treatment of thoracolumbar fractures, 2,16 although there is a substantial lack of scientific evidence for this technique. This minimally invasive approach might involve some important drawbacks.…”

Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Vaněk

Bradáč

Konopková

et al. 2014

SPI

112

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Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

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Section: Discussionmentioning

confidence: 99%

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Vaněk

Bradáč

Konopková

et al. 2014

SPI

112

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“…Complications Recent national data in over 66,000 patients found an overall complication rate of 13.07% after "open" posterior lumbar fusion for spondylolisthesis. 38,41,45,46 However, these low rates of complications have not been seen in all nonendoscopic, minimally invasive techniques when compared with open approaches, as in some minimally invasive transforaminal lumbar interbody fusion techniques. 37 In national databases, the most common method of determining a complication is by the occurrence of a billable event during the index hospitalization.…”

Section: Costs Of Mis Versus Open Spine Proceduresmentioning

confidence: 99%

“…Although endoscopic interbody fusion techniques have steep learning curves, endoscopic discectomies and other MIS transforaminal lumbar interbody fusions, MIS discectomies, etc., and mini-open approaches (e.g., lateral, mini-open, retroperitoneal interbody lumbar fusions) do not appear to exhibit the same level of technical difficulty that has negatively affected the widespread adoption of endoscopic fusion techniques. 46,49 This may profoundly affect the cost equation, and is highly beneficial from a societal perspective. Much can be learned from published reports on the learning curve, where complication rates are expected to be higher, as are OR times.…”

Section: Costs Of Mis Versus Open Spine Proceduresmentioning

confidence: 99%

The Economics of Minimally Invasive Spine Surgery

Allen¹,

Garfin²

2010

Spine

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Although the CE of MIS surgery is yet to be carefully studied, the few economic studies that do exist suggest that MIS has the potential to be a cost-effective intervention, but only if improved clinical outcomes are maintained (durable). Longer follow-up and better outcome and cost data are needed to determine if incremental CE exists with MIS techniques, versus open or nonsurgical interventions.

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“…Minimally-invasive surgery offers a relative advantage over open surgery, but ongoing improvements are still critical. 5,[7][8][9] Our team previously reported initial results of an innovative MIS technique, the enhanced recovery after surgery (ERAS) TLIF. The centerpiece of our global ERAS spine program for lumbar interbody fusion is this technique, which combines novel technologies such as endoscopic decompression and fusion, conscious sedation without general anesthesia, expandable cage technology, a small-caliber percutaneous pedicle screw fixation system, multimodal pain control including long-acting local analgesia, and osteobiologics.…”

Section: Introductionmentioning

confidence: 99%

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

Chang

Huang

et al. 2020

Neurospine

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The concept of enhanced recovery after surgery (ERAS) is relatively new to the neurosurgical field. The introduction of an ERAS protocol in lumbar fusion surgery has aimed to accelerate patient recovery from surgery by reducing in-hospital opioid consumption. Methods: Patients with 1-or 2-level degenerative lumbar spine disease and who underwent ERAS transforaminal lumbar interbody fusion (TLIF) were retrospectively reviewed. Patients' general demographic data, in-hospital opioid dosage (converted to morphine equivalents), and hospital stay were compared to those who underwent standard minimally-invasive (MIS)-TLIF. Results: Twenty-four patients who received ERAS TLIF (the ERAS group) were compared to a series of 24 patients who received standard MIS-TLIF (the MIS group). The demographic data were similar. The operation time and blood loss significantly favored ERAS TLIF. The average daily opioid consumption was remarkably lower in the ERAS group than the MIS group. Average opioid dosage throughout the entire in-hospital period was also significantly reduced in the ERAS group compared to the MIS group. The average length of hospital stay was substantially shorter in the ERAS group (1.4 ± 1.13 days vs. 4.0±1.98 days, p<0.001). Conclusion: The present study demonstrated a significant decline in the consumption of opioids and in the hospital length of stay for patients undergoing ERAS TLIF for 1-or 2-level degenerative lumbar spine disease.

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Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion

Abstract: It has been widely reported a vascular and neurologic damage of the lumbar muscles produced in the classic posterior approach for lumbar spinal fusions.

Cited by 60 publications

References 47 publications

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

The Economics of Minimally Invasive Spine Surgery

Less Opioid Consumption With Enhanced Recovery After Surgery Transforaminal Lumbar Interbody Fusion (TLIF): A Comparison to Standard Minimally-Invasive TLIF

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