Comparison of Surgical Outcomes between Minimally Invasive and Open Lumbar Laminectomy: Single Surgeon Experience

Presented at SMISS Annual Forum 2014
By Islam Elboghdady
With Kern Singh MD, Sreeharsha Nandyala BA, Alejandro Marquez-Lara MD, Eric Sundberg MD, Abbas Naqvi BS, Hamid Hassanzadeh MD, Anton Jorgensen MD, Khaled Aboushaala MD, Andrew Park MD,

Disclosures: Islam Elboghdady None Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th, Sreeharsha Nandyala BA None, Alejandro Marquez-Lara MD None, Eric Sundberg MD None, Abbas Naqvi BS None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Andrew Park MD None,

Introduction:
Minimally invasive spine surgery (MIS) has gained considerable attention for the management of spinal stenosis. However, the anecdotal evidence of comparable efficacy between MIS and open lumbar laminectomy has not been confirmed.

Aims/Objectives:
To highlight the differences in surgical outcomes between minimally invasive and open primary lumbar laminectomies.

Methods:
A retrospective review of 119 patients who underwent a primary 1 and 2 level lumbar laminectomy for degenerative spinal pathology by a single surgeon between 2005-2013 was performed. Patients were separated into MIS and open cohorts. Patient demographics, comorbidity Index (CCI), intraoperative parameters, perioperative outcomes, and postoperative complications were assessed. Statistical analysis was performed with independent sample T tests for continuous variables and Chi-square analysis for categorical data. An alpha level of <0.05 denoted statistical significance.

Results:
119 patients underwent a 1 or 2 level lumbar laminectomy (MIS n =85, 69.8%; Open n=34, 31.2%). Patient demographics, comorbidity burden, smoking status and preoperative visual analogue scale (VAS) scores were similar between cohorts. The MIS cohort demonstrated a similar mean procedural time (54.9±21.9 vs 62.9±21.5, p=0.19) but incurred less intraoperative blood loss (43.6±13.3 vs 85.5±50.3, p<0.05). Hospitalization and post-operative complications did not differ between cohorts. Both cohorts demonstrated similar improvements in postoperative VAS scores.

Conclusions:
Patients who underwent an MIS lumbar laminectomy incurred less intraoperative blood loss than those treated with an open technique. Both cohorts demonstrated similar length of hospitalization, postoperative complication rate, and clinical improvement. This retrospective, single surgeon series suggests that MIS techniques are an efficacious alternative to traditional open approaches and that both techniques enjoy successful patient outcomes.