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Minimally invasive fusion technique proves to be a safe, effective option to open approach
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GENEVA — A group of Los Angeles spine surgeons reported that minimally invasive transforaminal lumbar interbody fusion can be performed safely with superior surgical and functional outcomes compared to the more traditional open approach.
More orthopedic spinal surgeons are using minimally invasive interbody fusion and pedicle screw instrumentation techniques, but "we still don't know the long-term outcomes between open and minimally invasive transforaminal interbody fusion (TLIF)," said Larry T. Khoo, MD, of the UCLA Medical Center, who discussed the topic at Spine Week 2008, here.
The investigators conducted a randomized, prospective study of patients treated with open or minimally invasive TLIF treated by a single surgical group. The investigation included 96 patients who underwent the minimally invasive approach, while another 34 patients received the traditional open TLIF approach. All patients received either a one-level or two-level TLIF. Two patients were lost to follow-up.
As part of the minimally invasive approach, Khoo and colleagues performed an ipsilateral hemilaminectomy and total facectomy using a 20-mm tubular access for decompression, followed by discectomy, single interbody cage placement, and percutaneous pedicle screw instrumentation. Open procedures were performed via a standard wide dorsal exposure, open instrumentation and cage placement.
Patients who received the minimally invasive treatment had an average 105 cc blood loss, a surgical time of 156 minutes, and a total hospital stay of 2.9 days. The open surgical group had an average blood loss of 275 cc, 206 minutes for surgical time and a total hospital stay of 4.2 days.
"We also saw that the complication rate was higher with the open approach - almost 65% higher," Khoo said.
Screw placement accuracies were "nearly identical" in both groups based on postoperative CT images, he said.
Likewise, "The minimally invasive group scored as good as, if not better than, the open group in terms of Oswestry Disability Index and Visual Analog Scale scores," he said.
For more information:
- Khoo LT, Chen NF, Sheikh H, Armin S. Long-term outcomes of minimally invasive open transforaminal lumbar interbody fusion: Surgical results and outcomes in a series of 128 patients. Paper AB45. Presented at Spine Week 2008. Geneva, Switzerland.