Minimally Invasive Spine Surgery through Lumbar Decompression: Patient-Reported Outcomes from more than 9,000 Cases

Presented at SMISS Annual Forum 2018
By Reginald J. Davis MD
With Stefan Prada , Michael Weiss , Stephen Songhurst BS, Chip Wade ,

Disclosures: Reginald Davis MD None Stefan Prada None, Michael Weiss None, Stephen Songhurst BS None, Chip Wade None,

Introduction:

Open lumbar laminectomy has long been the treatment of choice for lumbar stenosis and other degenerative conditions. However, subsequent lumbar instability from open approaches has turned the attention to minimally invasive surgery (MIS) techniques. Recently, studies have demonstrated similar outcomes for minimally invasive decompression (MID) techniques when compared to open approaches.

Aims/Objectives:

The purpose of our study was to evaluate one of the largest MIS-MID cohorts for safety and efficacy in a free-standing ambulatory surgery center (ASC).

Methods:

From February 2012 to December 2017, 9,188 lumbar MIS-MID surgical cases were evaluated. Inclusion criteria required cases to have patient-reported outcomes (PROs) data at preoperative and one postoperative interval. The PROs were collected through surveys while the operative variables were extracted from electronic health records. The PROs survey includes a visual analog scale (VAS), Oswestry Disability Index (ODI) and a return to work (RTW) item. Operative variables include estimated blood loss (EBL), length of surgery (LOS) and intraoperative complications.

Results:

Significant improvements (p < .001) in both pain and disability from preoperative to postoperative were observed. The postoperative follow-up ranged from 90 to 2,021 days, resulting in a mean of 238.21 days (SD = 238.05). Mean VAS values improved from 6.21 to 3.65 from preoperative to postoperative, respectively. Similarly, mean ODI values improved from 46.14 to 27.32 from preoperative to postoperative, respectively. The RTW analysis, which included 6,569 cases, revealed that 86.07% of the sample reported returning to their usual occupation at the postoperative follow-up interval. Operative results extracted from about 30% of the sample demonstrated mean EBL and LOS values of 59.53 mL and 68.88 minutes, respectively. Only 57 (1.89%) of the 3,017 cases evaluated for intraoperative complications were marked, of which 52 were dura leaks. A sub-analysis of 497 MIS-MID cases was performed to demonstrate improvements from preoperative to postoperative along a continuum. The inclusion criteria required all cases to have pain and disability data at preoperative, as well as three-, six-, 12- and 24-months postoperative. Mean VAS values were 5.88, 2.97, 2.79, 2.83 and 3.11 with respect to preoperative, three-, six-, 12- and 24-months postoperative. Similarly, mean ODI values were 43.11, 21.08, 20.45, 20.57 and 23.01 with respect to preoperative, three-, six-, 12- and 24-months postoperative.

Conclusions:

We conclude that MIS-MID surgeries can be performed safely and effectively in a free-standing ASC. Additionally, MIS-MID surgeries result in few complications, minimal blood loss, short operative times and positive outcomes.