Clinical outcomes were similar between MIS, open lumbar interbody fusion groups

Peter G. Passias

Virginie LaFage

Patients who underwent minimally invasive lumbar interbody fusion experienced similar clinical outcomes compared with patients who underwent primary surgery, according to study results. The investigators also found no differences in operative time, inpatient length of stay, blood loss or rates of postoperative complications.

“One of the first and probably primary messages is that revision surgery is certainly not an exclusion criteria for minimally invasive approaches,” Peter G. Passias, MD, MS, study co-author and clinical associate professor of orthopedic in the division of spine surgery at NYU Langone Health, told Orthopedics Today. “In many cases, it has the potential to be successful.”

MIS vs open lumbar fusion

In a presentation at the North American Spine Society Annual Meeting, Virginie Lafage, PhD, said she, Passias and colleagues matched 44 patients undergoing MIS surgical lumbar interbody fusion with 110 patients undergoing open lumbar interbody fusion in terms of comorbidities and number of levels fused. Lafage noted the MIS group consisted of 60% primary and 40% revision procedures and the open group consisted of 46% primary and 53% revision procedures. Researchers compared operative time, estimated blood loss (EBL), use of laminectomy, number of intraoperative fusions between primary and revision groups, and length of stay or ICU stay between the two groups.

“Within the managed groups there was no significant difference any time that we took information between the primary and revision groups,” Lafage said.

The primary and revision cases within the two groups had no significant differences in surgical factors. However, results showed a trend toward greater EBL among patients undergoing revision surgery vs. primary surgery in the open group, according to Lafage.

“What we found is that within MIS, [the] revision group seems to have a lower rate of intraoperative complications and no other significant differences for MIS or for the open [surgery],” Lafage said.

Additional research needed

Despite the historical benefits of MIS surgery identified in the perioperative and early postoperative period, Passias noted that more patients with longer follow-up are needed.

“From a hypothetical point of view, we do not anticipate that there will be noticeable differences between these two groups with regards to mid- or long-term outcomes,” Passias said.

However, he said long-term results of issues such as pseudarthrosis and success of revision still need to be addressed.

“For cases of revision decompression, I think we need to look at the neurologic functional outcomes. The pain, sensitivity and those types of neurologic recoveries were not looked at in a granular way in this particular study,” Passias said. “We certainly need to expand upon our outcomes data, and we need to expand upon our success of revision fusion surgery data in the future.” – by Casey Tingle

Reference:

Bortz C, et al. Paper 41. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.

For more information:

Virginie Lafage, PhD, can be reached at Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021; email: ironsm@hss.edu.

Peter G. Passias, MD, FAAOS, can be reached at 761 Merrick Ave., Westbury, NY 11590; email: ryan.jaslow@nyulangone.org.

Disclosures: Lafage reports she is a paid presenter or speaker for DePuy Synthes and K2M; receives research support from DePuy Synthes, Medtronic, NuVasive and Stryker; is a paid consultant for Globus Medical; is a board or committee member for International Spine Study Group and the Scoliosis Research Society; and has stock or stock options in Nemaris Inc. Passias reports no relevant financial disclosures.