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Open TLIF associated with longer hospital stay, higher rates of ASD at 5 years

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BOSTON — Minimally invasive fusion, rather than open transforaminal lumbar interbody fusion, is recommended for single-level disc degeneration, according to a speaker here.

Vinay R. Deshmukh, MD, and colleagues conducted a study in which open transforaminal lumbar interbody fusion (TLIF) was associated with a nearly three-times-higher rate of surgery for symptomatic adjacent segment degeneration (ASD) compared with minimally invasive surgery (MIS) at 5 years after surgery (22.7% vs. 9.3%, respectively). Deshmukh presented the study results during the Congress of Neurological Surgery Annual Meeting.

“The results of were fairly impressive. MIS was significantly better in terms of the risk profile as well as efficacy,” Deshmukh said.

Risk profile and efficacy factors included decreased length of stay, reduced blood loss with an assessed need for transfusion, lower narcotic requirements, quicker return to work and greater number of patients who returned to work, he said.

During the nonrandomized, retrospective study, Deshmukh and colleagues followed-up patients for a minimum of 5 years — longer than in other studies of this kind, according to Deshmukh. Mean follow-up was 8.1 years in the MIS group and 8.6 years in the open group.

“Extended follow-up really does give you the opportunity to notice some things you would not necessarily notice with our typical 3- to 5-year follow-up,” Deshmukh said.

The study included 161 patients; 75 patients underwent open TLIF and 86 underwent MIS TLIF for the same indication. The patients in both groups were fused at different levels.

Patients who underwent a second surgery at the level above and below the original lumbar fusion were diagnosed with ASD, according to Deshmukh.

He and colleagues found an unexpected time line where, some time after about 48 months, the open group started returning for ASD surgery and the return-to-surgery rates for the MIS group leveled-off nearly completely. The reasoning for these differences in outcomes was uncertain, Deshmukh said, noting they may be due to several factors.

During the initial fusions, the number of cerebrospinal fluid leaks and surgical-site infections was not statistically significantly different between the groups, according to Deshmukh.

The researchers also found an improved ability to return to work seen in 67.2% of the MIS group compared with 42.6% of the open group, and length of stay was shorter in the MIS group than in the open group at about 3.5 days vs. 5.9 days. — by Susan M. Rapp

Reference:

Parker SL. Paper #152. Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Disclosure: Deshmukh receives royalties from Pioneer Surgical Technologies and is a consultant to NASCAR.