Minimally Invasive versus Open Lumbar Diskectomy: Analysis of Postoperative Narcotic Requirements

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

Disclosures: Abbas Naqvi BS 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, Islam Elboghdady None, Eric Sundberg MD None, Hamid Hassanzadeh MD None, Anton Jorgensen MD None, Khaled Aboushaala MD None, Junyoung Ahn None,

Introduction:
Compared to traditional open approaches, MIS techniques to the lumbar spine minimize soft tissue injury and shorten the recovery time without compromising outcomes. The question whether this technical advantage translates into a reduction in postoperative narcotic consumption, has not been ascertained.

Aims/Objectives:
To determine if a minimally invasive (MIS) approach for a lumbar diskectomy (LD) is associated with lower narcotic requirements compared to an open LD.

Methods:
A prospectively maintained database was retrospectively reviewed for patients undergoing a primary, single-level lumbar diskectomy. The selected cohort was further stratified based upon the surgical approach: MIS vs Open. Patient demographics, comorbidity burden (CCI), intra-operative parameters, and in-hospital complications, were assessed. Cumulative and daily in-hospital oral morphine equivalent (OME) doses (mg) were recorded and assessed with regards to the postoperative day (POD) of discharge. Statistical analysis was performed with a chi-squared test for categorical variables and Student-Test for continuous variables. OME means were compared utilizing non-parametric analysis to adjust for skewedness. A p-value of <0.05 denoted statistical significance.

Results:
There were 248 cases included in this analysis of which 202 (81.5%) were MIS and 46 (18.5%) were performed with an open approach. There were no significant differences in patient demographics or comorbidity burden between the two cohorts. MIS treated patients demonstrated shorter operative times (36.7±15.5 vs 56.6±18.1 min, p<0.05), less blood loss (38.3±12.9 vs 52.2±27.1 cc, p<0.05), and shorter hospitalizations (11.0±8.2 vs 16.8±14.3 hours, p<0.05) compared to patients treated with an open approach. In addition a greater proportion of MIS patients were discharged on POD 0 (89.8% vs 65.2%, p<0.05). There were no significant differences in the cumulative and daily narcotic requirement between MIS and open LD regardless of the day of discharge.

Conclusions:
MIS techniques for a single-level LD are associated with improved intraoperative parameters including shorter operative times and less blood loss. In addition, MIS-treated patients incurred a shorter hospital stay compared to patients treated with an open approach. Despite these advantages, MIS LD did not demonstrate a reduction in narcotic consumption in the immediate and early postoperative period compared to open LD.