Validation and Analysis of a Multi-site MIS Prospective Registry Through Sub-analysis of an MIS TLIF Subgroup

Abstract

Study DesignRetrospective analysis of multi-site, prospectively collected database.ObjectiveTo assess the validity and utility of a prospective spine registry by sub-analysis of patients treated with MIS TLIF.BackgroundThe MIS registry is a large-scale, multi-center series of prospectively collected clinical information on outcomes, complications, and adverse events for minimally invasive spine procedures for the treatment of degenerative lumbar conditions.MethodsAnalysis was performed on the MIS Prospective Registry database. A subgroup of patients treated by MIS TLIF technique was identified. Statistical analyses were performed on pre and post-operative data collected using validated health related quality of life outcome tools. Missing 1-year patient follow-up data was obtained through progressive correspondence modalities.ResultsData analysis was performed on 98 MIS TLIF patients (56 female, 42 male) with a median age of 64.5 years (range 25-91 years) which were extracted from a total registry population of 478 patients. The one year follow-up rate was 87%. A total of 64 single-level, 23 two-level, 3 three-level, and 3 combined TLIFs staged with an MIS lateral procedure were included. The primary surgical indications were spondylolisthesis (27%), central stenosis (25%), foraminal stenosis (14%), post-laminectomy syndrome (14%) and degenerative scoliosis (6%). The peri-operative blood transfusion rate was 3%. Complications included intraoperative dural tear (n = 3), deep wound infection (n = 2), superficial dehiscence/cellulitis (n = 2). There was a 4% re-operation rate at the 1 year post-operative time point. Half of patients were discharged within 2 days (range 1-11 days, mean 2.97 days, median 2 days). All patients that were discharged on the first post-operative day (n = 14) underwent a single-level MIS TLIF procedure and had significantly lower pre-op disability index score than those discharged on POD 3-5 (43.7 ± 15.5 vs. 56.0 ± 18.3, p = 0.04).Average ODI scores in the subgroup of patients that had reached the one year postoperative time point were 46.5 pre-op (n = 46), and 26.2 at 1 year post-op (n = 40, p = 0.0001). There was significant improvement in VAS scores: pre-operative (back = 6.7, leg = 5.4, n = 46), and 1 year post-operative (back = 3.2, leg = 1.7, n = 40, p = 0.0001). Patients with pre-operative ODI scores greater than 50 demonstrated significant improvement starting at the 6 week post-operative time point (24 point improvement, n = 46, p < 0.001). A pre-operative ODI between 35-50 showed significant improvement starting at 3 months (15.5 point improvement, n = 29, p = 0.05). Patients with a pre-operative ODI score less than 35 had an initial period of increased disability with a trend towards significant improvement by 3 months post-op (n = 20).ConclusionsInitial findings of the MIS Prospective Registry show patients can be enrolled in a relatively short time period and patient based questionnaires can successfully be obtained through a combination of clinic follow-up appointments and rem...

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

“…The pooled average early SSI rate among 14,517 patients was 2.1% (median, 2.6%; range, 0.5%–16.7%) [ 11 , 13 , 20 , 22 , 25 , 32 , 78 , 82–84 , 86 , 142 , 147 , 156 , 164 , 167 , 170 , 171 ] compared with 0.8% (median, 0.9%; range, 0.1%–4.7%) for pooled average late SSI rate among 12,238 patients [ 11 , 13 , 54 , 83 , 167 , 171 ]. In terms of specific types of spine operations, 52 studies evaluated SSI rates among patients who underwent spinal fusion [ 9 , 10 , 14 , 15 , 21 , 24 , 27 , 30 , 33 , 42 , 43 , 46 , 52 , 56 , 58 , 62 , 63 , 68–70 , 72 , 75 , 76 , 92 , 103 , 105 , 107–109 , 111 , 113–115 , 119 , 120 , 123 , 125 , 128 , 133 , 139 , 141–144 , 146 , 150 , 151 , 157 , 161 , 162 , 164 , 173 ]. The pooled average SSI rate was calculat...…”

Assessment of radiographic and clinical outcomes of an articulating expandable interbody cage in minimally invasive transforaminal lumbar interbody fusion for spondylolisthesis

“…10,11 Transforaminal lumbar interbody fusion (TLIF) has been shown to be an effective surgical procedure for spondylolisthesis, 4,9,13,22 and there is growing interest in whether minimally invasive surgery for TLIF (MIS TLIF) can provide the same benefits. 1,3,16,35 Although MIS TLIF is associated with a significant learning curve, increased use of fluoroscopy, and risk of nerve injury, 2,6,[26][27][28][44][45][46][47] its benefits over open TLIF include decreased operating time, decreased intraoperative blood loss, decreased hospital stay, improved cost-effectiveness, faster return to work, and decreased pain. 20,24,29,32,[37][38][39]42 One controversy with MIS TLIF is the ability to provide adequate reduction of spondylolisthesis and correction of radiographic parameters, or even whether such changes are necessary.…”

The Cost-Effectiveness of Vancomycin Powder in Lumbar Laminectomy

“…Reported literature values for baseline infection rates after lumbar laminectomy with fusion are 8.50%, while infection rates from lumbar laminectomy alone are 4.20%. 2 , 19 The average total hospital cost of revision following infection after lumbar laminectomy with fusion has been reported as $90 938, while the total hospital cost of revision for infected lumbar laminectomy alone is much lower at $21 060. 20 , 21 The product cost of vancomycin powder was obtained from our institution’s purchasing records and was found to be $3.06 per gram.…”