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Boadi BI, Ikwuegbuenyi CA, Inzerillo S, Dykhouse G, Bratescu R, Omer M, Kashlan ON, Elsayed G, Härtl R. Complications in Minimally Invasive Spine Surgery in the Last 10 Years: A Narrative Review. Neurospine 2024; 21:770-803. [PMID: 39363458 DOI: 10.14245/ns.2448652.326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 08/16/2024] [Indexed: 10/05/2024] Open
Abstract
OBJECTIVE Minimally invasive spine surgery (MISS) employs small incisions and advanced techniques to minimize tissue damage while achieving similar outcomes to open surgery. MISS offers benefits such as reduced blood loss, shorter hospital stays, and lower costs. This review analyzes complications associated with MISS over the last 10 years, highlighting common issues and the impact of technological advancements. METHODS A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines was conducted using PubMed, MEDLINE, Embase via OVID, and Cochrane databases, covering publications from January 2013 to March 2024. Keywords related to MISS and complications were used. Studies on adult patients undergoing MISS with tubular, uniportal, or biportal endoscopy, reporting intraoperative or postoperative complications, were included. Non-English publications, abstracts, and small case series were excluded. Data on MISS approach, patient demographics, and complications were extracted and reviewed by 2 independent researchers. RESULTS The search identified 880 studies, with 137 included after screening and exclusions. Key complications in cervical MISS were hematomas, transient nerve root palsy, and dural tears. In thoracic MISS, complications included cerebrospinal fluid leaks and durotomy. In lumbar MISS, common complications were incidental dural injuries, postoperative neuropathic conditions, and disc herniation recurrences. Complications varied by surgical approach. CONCLUSION MISS offers reduced anatomical disruption compared to open surgery, potentially decreasing nerve injury risk. However, complications such as nerve injuries, durotomies, and hardware misplacement still occur. Intraoperative neuromonitoring and advanced technologies like navigation can help mitigate these risks. Despite variability in complication rates, MISS remains a safe, effective alternative with ongoing advancements enhancing its outcomes.
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Affiliation(s)
- Blake I Boadi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
| | | | - Sean Inzerillo
- College of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Gabrielle Dykhouse
- Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - Rachel Bratescu
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
| | - Mazin Omer
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Osama N Kashlan
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
| | - Galal Elsayed
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, NY, USA
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Moorthy V, Goh GS, Cheong Soh RC. What Preoperative Factors Are Associated With Achieving a Clinically Meaningful Improvement and Satisfaction After Single-Level Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis? Global Spine J 2024; 14:1287-1295. [PMID: 36366979 PMCID: PMC11289563 DOI: 10.1177/21925682221139816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES The purpose of this study was to identify preoperative factors associated with clinically meaningful improvement, patient satisfaction and expectation fulfilment at 2 years follow-up in patients undergoing single-level TLIF for degenerative spondylolisthesis. METHODS Patients who underwent a primary, single-level TLIF for degenerative spondylolisthesis between 2006 and 2015 were identified from a prospectively maintained institutional spine registry. Baseline characteristics and PROMs including the Oswestry Disability Index (ODI), 36-Item Short-Form Physical Component Score (SF-36 PCS), Mental Component Score (SF-36 MCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain were collected preoperatively, at 1 month, 3 months, 6 months, and 2 years. RESULTS A total of 997 patients were included. Multivariate analyses showed that increasing age (OR 1.039, P < .001) and better preoperative ODI (OR .984, P = .018) were associated with achieving minimal clinically important difference (MCID) for VAS Back. Increasing age (OR 1.032, P = .007) and better preoperative VAS Back (OR .783, P < .001) were associated with achieving MCID for VAS Leg. Lower BMI (OR .952, P = .024) and better preoperative ODI (OR .976, P < .001) were associated with achieving MCID for SF-36 PCS. Importantly, a better preoperative SF-36 MCS was associated with MCID attainment for ODI (OR 1.038, P < .001), satisfaction (OR 1.034, P < .001) and expectation fulfilment (OR 1.024, P < .001). CONCLUSION Patients who were older, have less preoperative disability and better preoperative mental health were significantly more likely to attain clinically meaningful improvement in PROMs and postoperative satisfaction after single-level TLIF. Identification of these factors would aid surgeons in patient selection and surgical counselling for single-level TLIF.
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Affiliation(s)
- Vikaesh Moorthy
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Graham S. Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Dave BR, Marathe N, Mayi S, Degulmadi D, Rai RR, Patil S, Jadav K, Bali SK, Kumar A, Meena U, Parmar V, Amin P, Dave M, Krishnan PA, Krishnan A. Does Conventional Open TLIF cause more Muscle Injury when Compared to Minimally Invasive TLIF?-A Prospective Single Center Analysis. Global Spine J 2024; 14:93-100. [PMID: 35442112 PMCID: PMC10676181 DOI: 10.1177/21925682221095467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN Prospective, observational. OBJECTIVES The aim of our study was to assess the amount of reduction in lean muscle mass (LMM) of multifidus muscle (MFM) between conventional open Transforaminal lumbar interbody fusion (CO-TLIF) as compared to Minimally invasive spine Transforaminal lumbar interbody fusion (MIS-TLIF). METHODS This study was conducted between 2017 and 2020. It included 100 patients divided into two groups, 50 patients treated with CO-TLIF, 50 treated with MIS-TLIF. Only patients undergoing single level, primary lumbar fusion at L4-5 or L5-S1 level for degenerative pathologies were included. All patients were assessed by magnetic resonance imaging (MRI) scans 1-year post surgery. Measurements were performed using ImageJ image processing program. RESULTS Mean percentage reduction in LMM in CO-TLIF group was 45.52 ± 12.36% and MIS-TLIF group was 25.83 ± 9.64% [statistically significant (t = 8.78, P < .001)]. Mean percentage reduction in LMM on side of cage insertion was 39.63 ± 15.96% and opposite side was 31.40 ± 15.01% [statistically significant (t = 9.06, P < .001)]. Mean reduction of LMM among males was 29.38 ± 15.23% and females was 40.42 ± 12.67% [statistically significant (t = -3.95, P < .001)].We observed significant but weak degree of correlation between age and percentage reduction of LMM (r = .22, P = .028). CONCLUSION Mean reduction in LMM was greater in CO-TLIF group as compared to MIS-TLIF. There was greater reduction in LMM in females and on side of cage insertion. We also found greater reduction in LMM with increasing age in both groups.
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Affiliation(s)
- Bharat R. Dave
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Nandan Marathe
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Shivanand Mayi
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | | | - Ravi Ranjan Rai
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Sameer Patil
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Kirit Jadav
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Shiv K. Bali
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Arvind Kumar
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Umesh Meena
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Vatsal Parmar
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Prarthan Amin
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | - Mirant Dave
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
| | | | - Ajay Krishnan
- Stavya Spine Hospital & Research Institute, Ahmedabad, Gujarat, India
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Lewis D, Marya S, Carrasco R, Sabou S, Leach J. Comparative Outcome Data Using Different Techniques for Posterior Lumbar Fusion: A Large Single-Center Study. Asian Spine J 2023; 17:807-817. [PMID: 37788973 PMCID: PMC10622816 DOI: 10.31616/asj.2022.0448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 10/05/2023] Open
Abstract
STUDY DESIGN Retrospective single-center study. PURPOSE This study aims to evaluate perioperative and intermediate-term clinical outcomes of patients undergoing different lumbar fusion techniques. OVERVIEW OF LITERATURE Various open and minimally invasive techniques for lumbar fusion are available, but previous studies comparing lumbar fusion techniques have heterogeneous data, making interpretation challenging. METHODS Between 2011 and 2018, data from 447 consecutive patients undergoing one/two-level lumbar fusion were analyzed. Posterior lumbar interbody fusion (PLIF) with bilateral muscle strip or Wiltse approach, open transforaminal lumbar interbody fusion (TLIF) and minimally invasive TLIF, and posterolateral fusion only were among the surgical techniques used. Core outcomes measure index (COMI) questionnaires were distributed before surgery and at 3 months, 1 year, and 2 years postoperatively to establish patient selfreported outcome measures. Demographic data (age, gender, and body mass index [BMI]) for each patient were also collected in addition to surgical indication, previous operative history, perioperative outcomes, and complications, and whether later revision surgery was required. Pearson's chi-square test, Kruskal-Wallis test, repeated measure mixed-effects models, and ordinal logistic regression were used for statistical analysis. RESULTS Postoperative COMI scores improved across all procedures compared with pre-surgery (p<0.001). There was no significant difference between different postoperative COMI scores. Significant predictors of higher postoperative COMI score included higher pretreatment COMI score (p≤0.001), previous surgery (p≤0.04), younger age (p≤0.05), higher BMI (p≤0.005), and the indications of lytic spondylolisthesis (p=0.02) and degenerative disc disease (p<0.001). Patients undergoing minimally invasive TLIF had a significantly shorter post-surgery stay than patients undergoing open PLIF (Kruskal-Wallis test, p=0.03). CONCLUSIONS At 2 years postoperatively, there was no significant difference in clinical outcomes between open and minimally invasive techniques. These findings suggest that the main determinant of surgical approach should be surgeon preference and training.
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Affiliation(s)
- Daniel Lewis
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,
UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester,
UK
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,
UK
| | - Shivan Marya
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
| | - Roberto Carrasco
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester,
UK
| | - Silviu Sabou
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
| | - John Leach
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,
UK
- Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester,
UK
- Department of Spinal Surgery, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Trust, Manchester Academic Health Science Centre, Manchester,
UK
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