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Shahi P, Vaishnav AS, Mai E, Kim JH, Dalal S, Song J, Shinn DJ, Melissaridou D, Araghi K, Urakawa H, Sivaganesan A, Lafage V, Qureshi SA, Iyer S. Practical answers to frequently asked questions in minimally invasive lumbar spine surgery. Spine J 2023; 23:54-63. [PMID: 35843537 DOI: 10.1016/j.spinee.2022.07.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/03/2022] [Accepted: 07/11/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Surgical counseling enables shared decision-making (SDM) by improving patients' understanding. PURPOSE To provide answers to frequently asked questions (FAQs) in minimally invasive lumbar spine surgery. STUDY DESIGN Retrospective review of prospectively collected data. PATIENT SAMPLE Patients who underwent primary tubular minimally invasive lumbar spine surgery in form of transforaminal lumbar interbody fusion (MI-TLIF), decompression alone, or microdiscectomy and had a minimum of 1-year follow-up. OUTCOME MEASURES (1) Surgical (radiation exposure and intraoperative complications) (2)Immediate postoperative (length of stay [LOS] and complications) (3) Clinical outcomes (Visual Analog Scale- back and leg, VAS; Oswestry Disability Index, ODI; 12-Item Short Form Survey Physical Component Score, SF-12 PCS; Patient-Reported Outcomes Measurement Information System Physical Function, PROMIS PF; Global Rating Change, GRC; return to activities; complications/reoperations) METHODS: The outcome measures were analyzed to provide answers to ten FAQs that were compiled based on the authors' experience and a review of literature. Changes in VAS back, VAS leg, ODI, and SF-12 PCS from preoperative values to the early (<6 months) and late (>6 months) postoperative time points were analyzed with Wilcoxon Signed Rank Tests. % of patients achieving minimal clinically important difference (MCID) for these patient-reported outcome measures (PROMs) at the two time points was evaluated. Changes in PROs from preoperative values too early (<6 months) and late (≥6 months) postoperative time points were analyzed within each of the three groups. Percentage of patients achieving MCID was also evaluated. RESULTS Three hundred sixty-six patients (104 TLIF, 147 decompression, 115 microdiscectomy) were included. The following FAQs were answered: (1) Will my back pain improve? Most patients report improvement by >50%. About 60% of TLIF, decompression, and microdiscectomy patients achieved MCID at ≥6 months. (2) Will my leg pain improve? Most patients report improvement by >50%. 56% of TLIF, 67% of decompression, and 70% of microdiscectomy patients achieved MCID at ≥6 months. (3) Will my activity level improve? Most patients report significant improvement. Sixty-six percent of TLIF, 55% of decompression, and 75% of microdiscectomy patients achieved MCID for SF-12 PCS. (4) Is there a chance I will get worse? Six percent after TLIF, 14% after decompression, and 5% after microdiscectomy. (5) Will I receive a significant amount of radiation? The radiation exposure is likely to be acceptable and nearly insignificant in terms of radiation-related risks. (6) What is the likelihood that I will have a complication? 17.3% (15.4% minor, 1.9% major) for TLIF, 10% (9.3% minor and 0.7% major) for decompression, and 1.7% (all minor) for microdiscectomy (7) Will I need another surgery? Six percent after TLIF, 16.3% after decompression, 13% after microdiscectomy. (8) How long will I stay in the hospital? Most patients get discharged on postoperative day one after TLIF and on the same day after decompression and microdiscectomy. (9) When will I be able to return to work? >80% of patients return to work (average: 25 days after TLIF, 14 days after decompression, 11 days after microdiscectomy). (10) Will I be able to drive again? >90% of patients return to driving (average: 22 days after TLIF, 11 days after decompression, 14 days after microdiscectomy). CONCLUSIONS These concise answers to the FAQs in minimally invasive lumbar spine surgery can be used by physicians as a reference to enable patient education.
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Affiliation(s)
- Pratyush Shahi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Avani S Vaishnav
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Eric Mai
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY , USA
| | - Jeong Hoon Kim
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY , USA
| | - Sidhant Dalal
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Daniel J Shinn
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Dimitra Melissaridou
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Kasra Araghi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Hikari Urakawa
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Ahilan Sivaganesan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA; Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY , USA.
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th St., New York, NY, USA; Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY , USA
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Pawar A, Hughes A, Girardi F, Sama A, Lebl D, Cammisa F. Lateral Lumbar Interbody Fusion. Asian Spine J 2015; 9:978-83. [PMID: 26713134 DOI: 10.4184/asj.2015.9.6.978] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 04/05/2015] [Accepted: 04/05/2015] [Indexed: 11/08/2022] Open
Abstract
The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques.
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