Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study

Does surgical site infection affect patient-reported outcomes after spinal surgery? A multicenter cohort study

BACKGROUND

Surgical site infections are common in spinal surgeries. It is uncertain whether outcomes in spine surgery patients with vs. without surgical site infection are equivalent. Therefore, we assessed the effects of surgical site infection on postoperative patient-reported outcomes.

METHODS

We enrolled patients who underwent elective spine surgery at 12 hospitals between April 2017 and February 2020. We collected data regarding the patients' backgrounds, operative factors, and incidence of surgical site infection. Data for patient-reported outcomes, namely numerical rating scale, Neck Disability Index/Oswestry Disability Index, EuroQol Five-Dimensional questionnaire, and 12-Item Short-Form Health Survey scores, were obtained preoperatively and 1 year postoperatively. We divided the patients into with and without surgical site infection groups. Multivariate logistic regression analyses were performed to identify the risk factors for surgical site infection. Using propensity score matching, we obtained matched surgical site infection-negative and -positive groups. Student's t-test was used for comparisons of continuous variables, and Pearson's chi-square test was used to compare categorical variables between the two matched groups and two unmatched groups.

RESULTS

We enrolled 8861 patients in this study; 74 (0.8 %) developed surgical site infections. Cervical spine surgery and American Society of Anesthesiologists physical status classification ≥3 were identified as risk factors; microendoscopy was identified as a protective factor. Using propensity score matching, we compared surgical site infection-positive and -negative groups (74 in each group). No significant difference was found in postoperative pain or dysesthesia of the lower back, buttock, leg, and plantar area between the groups. When comparing preoperative with postoperative pain and dysesthesia, statistically significant improvement was observed for both variables in both groups (p < 0.01 for all variables). No significant differences were observed in postoperative outcomes between the matched surgical site infection-positive and -negative groups.

CONCLUSIONS

Patients with surgical site infections had comparable postoperative outcomes to those without surgical site infections.

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

This study compared the outcomes of microendoscopy-assisted lumbar interbody fusion (ME-LIF) and uniportal full-endoscopic laminectomy (FEL) for L5 radiculopathy caused by lumbar foraminal stenosis (LFS). ME-LIF was performed using an 18- to 20-mm tubular retractor and endoscope, and FEL via the translaminar approach (TLA) was performed at the dorsal part of the foramen using a 4.1-mm working channel endoscope. Patients with LFS treated using ME-LIF (n = 39) or FEL-TLA (n = 30) were retrospectively evaluated. Patients' background and operative data were collected. The 36-item Short Form Survey (SF-36), Oswestry Disability Index (ODI), and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 2 years postoperatively. The background data of the two groups (ME-LIF and FEL-TLA) were similar. The mean operation times for ME-LIF and FEL-TLA were 110.7 and 65.2 min, respectively, and the mean length of hospital stay were 10.3 and 1.5 days, respectively. Reoperation was required for surgical site infection, and percutaneous pedicle screw malposition in three patients was treated using ME-LIF. During follow-up, second FEL-TLA and LIF were performed for recurrent L5 radiculopathy in one and three patients in the FEL-TLA group, respectively. Although the SF-36, ODI, and EQ-5D scores 2 years postoperatively improved in both groups, improvement in ODI scores was lower following FEL-TLA than following ME-LIF. FEL-TLA can be performed to treat patients with L5 radiculopathy caused by LFS. Although the ODI score improvement following FEL-TLA was unremarkable, FEL-TLA might be considered because of its better safety profile and minimal invasiveness than ME-LIF.