Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review |
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Authors: | Branko Skovrlj Patrick Belton Hekmat Zarzour Sheeraz A Qureshi |
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Affiliation: | Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United StatesPatrick Belton, State University of New York Upstate Medical University, Syracuse, NY 13210, United StatesSheeraz A Qureshi, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States |
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Abstract: | AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).METHODS: A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time. |
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Keywords: | Minimally invasive Spine surgery Lumbar spine Perioperative outcomes Estimated blood loss Neurologic complications Transfusion Postoperative pain Narcotic use Length of stay Length of surgery |
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