Minimally Invasive Tubular Lumbar Discectomy Versus Conventional Open Lumbar Discectomy: An Observational Study From the Canadian Spine Outcomes and Research Network

Study Design: Retrospective cohort study. Objective: We evaluated the effectiveness of minimally invasive (MIS) tubular discectomy in comparison to conventional open surgery among patients enrolled in the Canadian Spine Outcomes and Research Network (CSORN). Methods: We performed an observational analysis of data that was prospectively collected. We implemented Minimum Clinically Important Differences (MCIDs), and we adjusted for potential confounders with multiple logistic regression. Adverse events were collected according to the Spinal Adverse Events Severity (SAVES) protocol. Results: Three hundred thirty-nine (62%) patients underwent MIS tubular discectomy and 211 (38%) underwent conventional open discectomy. There were no significant differences between groups for improvement of leg pain and disability, but the MIS technique was associated with reduced odds of achieving the MCID for back pain (OR 0.66, 95% CI 0.44 to 0.99, P < 0.05). We identified statistically significant differences in favor of MIS for each of operating time (MIS mean (SD) 72.2 minutes (30.0) vs open 93.5 (40.9)), estimated blood loss (MIS 37.9 mL (36.7) vs open 76.8 (71.4)), length of stay in hospital (MIS 73% same-day discharge vs open 40%), rates of incidental durotomy (MIS 4% vs open 8%), and wound-related complications (MIS 3% vs open 9%); but not for overall rates of reoperation. Conclusions: Open and MIS techniques yielded similar improvements of leg pain and disability at up to 12 months of follow-up, but MIS patients were less likely to experience improvement of associated back pain. Small differences favored MIS for operating time, blood loss, and adverse events but may have limited clinical importance.

Download Full-text

Minimally Invasive versus Open Thoracolumbar Surgery for Lumbar Spinal Stenosis in Patients with Diabetes: A CSORN Study

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9773 ◽

2021 ◽

pp. 13

Author(s):

Kalpesh Hathi

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Research Network ◽

Leg Pain ◽

Number Of Patients ◽

Patients With Diabetes ◽

One Year ◽

Lumbar Spinal

Introduction: This study was aimed at comparing outcomes of minimally invasive (MIS) versus OPEN surgery for lumbar spinal stenosis (LSS) in patients with diabetes. Methodology: This retrospective cohort study included patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database. Outcomes of MIS and OPEN approaches were compared for two cohorts: (i) patients with diabetes who underwent decompression alone (N = 116; MIS, n = 58, OPEN, n = 58) and (ii) patients with diabetes who underwent decompression with fusion (N = 108; MIS, n = 54, OPEN, n = 54). Mixed measures analyses of covariance compared modified Oswestry Disability Index (mODI) and back and leg pain at one-year post operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at one year were compared. Result: MIS approaches had less blood loss (decompression alone difference 99.66 mL, p = 0.002; with fusion difference 244.23, p < 0.001) and shorter LOS (decompression alone difference 1.15 days, p = 0.008; with fusion difference 1.23 days, p = 0.026). MIS compared to OPEN decompression with fusion had less patients experience an adverse event (difference, 13 patients, p = 0.007). The MIS decompression with fusion group had lower one-year mODI (difference, 14.25, p < 0.001) and back pain (difference, 1.64, p = 0.002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at one year for mODI (MIS 75.9% vs OPEN 53.7%, p = 0.028) and back pain (MIS 85.2% vs OPEN 70.4%, p = 0.017). Conclusion: MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

Download Full-text

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

Neurosurgical FOCUS ◽

10.3171/2010.1.focus09272 ◽

2010 ◽

Vol 28 (3) ◽

pp. E6 ◽

Cited By ~ 159

Author(s):

Neel Anand ◽

Rebecca Rosemann ◽

Bhavraj Khalsa ◽

Eli M. Baron

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Short Form ◽

Operating Time ◽

Adult Scoliosis ◽

Estimated Blood Loss ◽

The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

Download Full-text

Comparison of Single-Level Open and Minimally Invasive Transforaminal Lumbar Interbody Fusions Presenting a Learning Curve

BioMed Research International ◽

10.1155/2020/3798537 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Viktor Zs. Kovari ◽

Akos Kuti ◽

Krisztina Konya ◽

Istvan Szel ◽

Anna K. Szekely ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Blood Transfusion ◽

Blood Loss ◽

Minimally Invasive ◽

Learning Curve ◽

Operative Time ◽

Leg Pain ◽

Low Back ◽

Single Level

Background. Comparison of single-level open and minimally invasive transforaminal lumbar interbody fusions (O-TLIF and MI-TLIF) of a single surgeon and presentation of his MI-TLIF learning curve in a retrospective observational cohort study. Methods. 27 MI-TLIF and 31 O-TLIF patients, performed between 03/01/2013 and 03/31/2018, were compared regarding the operative time, blood loss, blood transfusion frequency, postoperative length of stay (LOS), and adverse events. An overall comparison of pre- and postoperative Oswestry Disability Index (ODI) results and Visual Analog Score (VAS) results of low back and leg pain was performed in the case of the two techniques. For a learning curve presentation, the MI-TLIF cases were compared and the optimal operative time was determined. Results. The gender ratio and age did not differ in the groups. Operative time showed no difference (P=0.88) between the MI-TLIF (161.2 ± 33.7 minutes) and O-TLIF groups (160 ± 33.6 minutes). Intraoperative blood loss was less (P≤0.001) in the MI-TLIF group (288.9 ± 339.8 mL) than in the O-TLIF group (682.3 ± 465.4 mL) while the incidence of blood transfusion was similar (P=0.64). The MI-TLIF group had shorter LOS (2.7 ± 1.1 days vs. 5 ± 2.7, P≤0.001). The frequencies of the surgical site infections (SSI), durotomy, new motor, and sensory deficit were not significantly different (P=0.17, 0.5, 0.29, 0.92). All the ODI, the VAS low back pain, and the VAS leg pain scores improved in both groups significantly (P≤0.001, P≤0.001, and P≤0.001 in the MI-TLIF group and P≤0.001, P≤0.001, and P≤0.001 in the O-TLIF group). The comparison of the pre- and postoperative results of the ODI and VAS questionnaires of the two techniques showed no significant difference regarding the improvement of these scores (MI-TLIF versus O-TLIF pre- and postoperative ODI difference p=0.64, VAS low back pain P=0.47, and VAS leg pain P=0.21). Assessing the MI-TLIF learning curve, operative time was shortened by 63 minutes (P=0.04). After the 14th MI-TLIF case, the surgical duration became relatively constant. Comparing the 14th and previous MI-TLIF cases to the later cases, LOS showed reduction by 1.03 days (P=0.01), while the other parameters did not show significant changes. Conclusions. Similar operative time and postoperative quality of life improvement can be achieved by MI-TLIF procedure as with O-TLIF, and additionally LOS and blood loss can be reduced. When comparing parameters, MI-TLIF can be an alternative option for O-TLIF with a similar complication profile. The learning curve of MI-TLIF can be steep, although it depends on the circumstances.

Download Full-text

Minimally Invasive L5 Corpectomy with Navigated Expandable Vertebral Cage: A Technical Note

Brain Sciences ◽

10.3390/brainsci11091241 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1241

Author(s):

Taro Yamauchi ◽

Ashish Jaiswal ◽

Masato Tanaka ◽

Yoshihiro Fujiwara ◽

Yoshiaki Oda ◽

...

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Lower Back Pain ◽

Revision Surgery ◽

Leg Pain ◽

Decompression Surgery ◽

Intraoperative Radiation ◽

Lower Back ◽

Estimated Blood Loss ◽

L5 Corpectomy

Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. Results: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 mL. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. Conclusions: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Download Full-text

Perioperative results following lumbar discectomy: comparison of minimally invasive discectomy and standard microdiscectomy

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e20 ◽

2008 ◽

Vol 25 (2) ◽

pp. E20 ◽

Cited By ~ 60

Author(s):

John W. German ◽

Mathew A. Adamo ◽

Regis G. Hoppenot ◽

Jessin H. Blossom ◽

Henry A. Nagle

Keyword(s):

Cerebrospinal Fluid ◽

Length Of Stay ◽

Blood Loss ◽

Minimally Invasive ◽

Operative Time ◽

Cerebrospinal Fluid Leak ◽

Lumbar Discectomy ◽

Estimated Blood Loss ◽

Fluid Leak ◽

First Time

Object Minimally invasive lumbar discectomy is a refinement of the standard open microsurgical discectomy technique. Proponents of the minimally invasive technique suggest that it improves patient outcome, shortens hospital stay, and decreases hospital costs. Despite these claims there is little support in the literature to justify the adoption of minimally invasive discectomy over standard open microsurgical discectomy. In the present study, the authors address some of these issues by comparing the short-term outcomes in patients who underwent first time, single-level lumbar discectomy at L3–4, L4–5, or L5–S1 using either a minimally invasive percutaneous, muscle splitting approach or a standard, open, muscle-stripping microsurgical approach. Methods A retrospective chart review of 172 patients who had undergone a first-time, single-level lumbar discectomy at either L3–4, L4–5, or L5–S1 was performed. Perioperative results were assessed by comparing the following parameters between patients who had undergone minimally invasive discectomy and those who received standard open microsurgical discectomy: length of stay, operative time, estimated blood loss, rate of cerebrospinal fluid leak, post-anesthesia care unit narcotic use, need for a physical therapy consultation, and need for admission to the hospital. Results Forty-nine patients underwent minimally invasive discectomy, and 123 patients underwent open microsurgical discectomy. At baseline the groups did differ significantly with respect to age, but did not differ with respect to height, weight, sex, body mass index, level of radiculopathy, side of radiculopathy, insurance status, or type of preoperative analgesic use. No statistically significant differences were identified in operative time, rate of cerebrospinal fluid leak, or need for a physical therapy consultation. Statistically significant differences were identified in length of stay, estimated blood loss, postanesthesia care unit narcotic use, and need for admission to the hospital. Conclusions In this retrospective study, patients who underwent minimally invasive discectomy were found to have similiar perioperative results as those who underwent open microsurgical discectomy. The differences, although statistically significant, are of modest clinical significance.

Download Full-text

Comparison of Early Outcomes between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis

10.21203/rs.3.rs-89182/v1 ◽

2020 ◽

Author(s):

Hao Zhang ◽

Chuanli Zhou ◽

Chao Wang ◽

Kai Zhu ◽

Qihao Tu ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Operative Time ◽

Japanese Orthopaedic Association ◽

Transforaminal Lumbar Interbody Fusion ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Lumbar Spondylolisthesis

Abstract BackgroundWith the rapid development of less-invasive techniques, the percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) as a novel minimal surgical technique for treating lumbar spondylolisthesis in recent years. To compare the preliminary efficacy of Endo-TLIF with that of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar spondylolisthesis.MethodsBetween May and August 2019, 62 patients with single-segment lumbar spondylolisthesis treated by a single surgeon were enrolled in this clinical study: there were 32 patients in the Endo-TLIF group and 30 patients in the MIS-TLIF group. Perioperative parameters, including operative time, estimated blood loss (EBL), interoperative fluoroscopy time, ambulation time and operative complications, were recorded. At preoperatively, 1 week, 3 months, 6 months and 12 months postoperatively, the results of clinical metrics such as the Visual Analog Scale (VAS) for back pain, the Oswestry Disability Index (ODI) and the Japanese Orthopaedic Association (JOA) score were obtained and used to compare early outcomes between the two groups. Postoperative fusion rates were assessed by CT scans 12 months after surgery.ResultsNo significant differences were found in the demographic data, including sex, age, body mass index (BMI), segment distribution and spondylolisthesis severity, between the two groups. Compared with MIS-TLIF group, Endo-TLIF group had a similar operative time (202.6±31.4 minutes), less intraoperative blood loss (73.0±26.0 ml) and a shorter ambulation time (1.6±0.6 days) but had a longer duration of X-ray radiation (46.3±5.1 seconds). The postoperative VAS scores for back pain as well as the ODI and JOA scores were improved compared with the preoperative scores in the two groups, but the Endo-TLIF group showed more significant improvement in the early follow-up. There were no significant differences in terms of the interbody fusion rate between the two groups. However, no obvious postoperative complications were observed in the study.ConclusionEndo-TLIF technique shows relatively better outcomes compared with MIS-TLIF in terms of an early curative effect, especially one week and six months postoperatively.

Download Full-text

Efficacy of a Laparoscopic Saline-Coupled Bipolar Sealer in Minimally Invasive Hepatobiliary Surgery

Surgical Innovation ◽

10.1177/1553350619855282 ◽

2019 ◽

Vol 26 (6) ◽

pp. 668-674

Author(s):

Amit Sastry ◽

Jesse K. Sulzer ◽

Michael Passeri ◽

Erin H. Baker ◽

Dionisios Vrochides ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hepatic Resection ◽

Operating Time ◽

Bipolar Devices ◽

Estimated Blood Loss ◽

Minimally Invasive Hepatectomy ◽

Clavien Grade ◽

Average Operating ◽

Average Operating Time

Hepatic resection presents unique surgical challenges to reduce blood loss during parenchymal division. The development of saline-coupled bipolar devices, in which hemostasis is achieved at lower temperatures than electrocautery or other bipolar sealing devices, have been employed for open hepatic resection. Saline-coupled bipolar devices have now become available for minimally invasive use. The goals of this study were to evaluate the feasibility and safety of a laparoscopic saline-coupled bipolar device for minimally invasive hepatectomy. Seventeen patients (median age 66 years, range 36-81) were consented for inclusion and enrolled. Patient demographics, intraoperative data, and surgeon feedback were collected. Seven robot-assisted partial hepatectomies, 9 laparoscopic partial hepatectomies, and 1 laparoscopic cholecystectomy with liver abscess resection were performed. Average operating time was 222 ± 33 minutes (median 188 minutes; range 61-564 minutes) with no difference between robotic versus laparoscopic time. Successful seals were achieved in all cases following application of 150 to 200 J energy (average 179 ± 3 J, average time to achieve a successful seal 9.3 ± 2.7 minutes). Estimated blood loss was 362 ± 74 mL (median 300 mL, range 5-1200 mL) and 3/17 patients received intraoperative blood transfusion. No bile leaks were detected in any of the patients. Median length of stay was 5 days (range 1-20 days), and there were no readmissions within 30 days. Postoperative morbidity occurred in 5/17 patients, all of which were Clavien Grade 1. There was no mortality within 90 days or complications requiring a return to the operating room, and there were no liver-specific morbidities. These data suggest the laparoscopic Aquamantys device represents a useful device for use in minimally invasive liver resection.

Download Full-text

Triangular Fixation to Prevent Proximal Screw Pullout in Adult Spinal Deformity Surgery: A Technical Note

10.21203/rs.3.rs-968617/v1 ◽

2021 ◽

Author(s):

Masato Tanaka ◽

Rahul Mehta ◽

Taro Yamauchi ◽

Shinya Arataki ◽

Koji Uotani ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Adult Spinal Deformity ◽

Operation Time ◽

Low Back ◽

Lower Back ◽

Estimated Blood Loss ◽

Proximal Screw

Abstract Background Adult spinal deformity (ASD) is caused by spinal malalignment and results in severe low back pain, neurological dysfunction, and severe deformity. Proximal screw back-out represents a difficult problem in minimally invasive ASD surgery. We describe a novel technique to prevent screw pullout in ASD. Methods A 71-year-old woman was referred to our hospital with severe low back pain and gait difficulty. Her daily life had been affected by severe lower back pain for more than 6 months. Standing radiograms indicated severe kyphoscoliosis. Two-stage minimally invasive corrective T10-to-pelvis fixation was performed. Results The first surgery was an L1–S1 C-arm-free oblique lumbar interbody fusion, with an operation time of 3 h 57 min and an estimated blood loss of 240 mL. After 1 week, the second percutaneous pedicle screw (PPS) fixation was performed and proximal screws were inserted under a transdiscal approach (T11) and with a lower angulation trajectory (T10) to enhance pullout strength. For this second surgery, operation time was 3 h 33 min, and estimated blood loss was 320 mL. No postoperative complications or neurological compromise was reported. In terms of clinical outcomes, Oswestry Disability Index improved from 56–24%, and visual analog scale score for lower back pain improved from 62 mm to 24 mm at the 1-year follow-up. Conclusions Minimally invasive circumferential surgery with triangular fixation is effective for preventing proximal screw back-out and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure.

Download Full-text

Clinical and radiographic outcomes of oblique lateral lumbar interbody fusion and minimally-invasive transforaminal lumbar interbody fusion in patients with grade-1 degenerative spondylolisthesis

10.21203/rs.2.21425/v1 ◽

2020 ◽

Author(s):

Da He ◽

Wei He ◽

Yajun Liu ◽

Yuqing Sun ◽

Yonggang Xing ◽

...

Keyword(s):

Back Pain ◽

Blood Loss ◽

Minimally Invasive ◽

Interbody Fusion ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Lumbar Interbody Fusion ◽

Radiographic Outcomes ◽

Cage Subsidence ◽

Vas Scores

Abstract Background: The most effective lumbar interbody fusion (LIF) technique for degenerative spondylolisthesis remains controversial. Methods: This is a retrospective study. This comparative analysis included consecutive patients with grade-1 degenerative spondylolisthesis who underwent oblique LIF (OLIF) or minimally-invasive transforaminal LIF (MI-TLIF) at the Department of Spine Surgery, our hospital(January 2016 to August 2017). Patient satisfaction (Japanese Orthopaedic Association score), visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), radiographic outcomes including anterior/posterior disc heights (ADH/PDH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion and fusion rate were assessed during a 2-year follow-up. Results: The OLIF and MI-TLIF groups comprised 36 patients (age, 52.1±7.2 years; 27 women) and 45 patients (age, 48.4±14.4 years; 24 women) respectively. Satisfaction rates at 2 years exceeded 90% in both groups. The OLIF group had less intraoperative blood loss (140±36 vs. 233±62 mL), lower back pain VAS score (2.42±0.81 vs. 3.38±0.47) and ODI score (20.47±2.53 vs. 27.31±3.71) at 3 months (with trends toward lower values at 2 years), but higher leg pain VAS scores at all postoperative time points than the MI-TLIF group (all P<0.001). ADH, PDH, FD and FW improved in both groups after surgery. At 2 years, the OLIF group had a higher rate of Bridwell grade-I fusion (100% vs. 88.9%, P=0.046) and lower incidences of cage subsidence (8.33% vs. 46.67%, P<0.001) and retropulsion (0% vs. 6.67%, P=0.046). Conclusions: In patients with grade-I spondylolisthesis, OLIF was associated with less blood loss and better improvements in some clinical(VAS for back pain and ODI) and radiologic outcomes than MI-TLIF, although patients in the OLIF group had higher leg pain VAS scores than patients in the MI-TLIF group.

Download Full-text

Minimally Invasive vs. Open Surgery for Lumbar Spinal Stenosis in Patients with Diabetes – A Canadian Spine Outcomes and Research Network Study

Global Spine Journal ◽

10.1177/21925682211042576 ◽

2021 ◽

pp. 219256822110425

Author(s):

Kalpesh Hathi ◽

Erin Bigney ◽

Eden Richardson ◽

Tolu Alugo ◽

Dana El-Mughayyar ◽

...

Keyword(s):

Back Pain ◽

Minimally Invasive ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Open Surgery ◽

Research Network ◽

Leg Pain ◽

Number Of Patients ◽

Patients With Diabetes ◽

Lumbar Spinal

Study Design Retrospective cohort. Objectives To compare outcomes of minimally invasive surgery (MIS) vs open surgery (OPEN) for lumbar spinal stenosis (LSS) in patients with diabetes. Methods Patients with diabetes who underwent spinal decompression alone or with fusion for LSS within the Canadian Spine Outcomes and Research Network (CSORN) database were included. MIS vs OPEN outcomes were compared for 2 cohorts: (1) patients with diabetes who underwent decompression alone (N = 116; MIS n = 58 and OPEN n = 58), (2) patients with diabetes who underwent decompression with fusion (N = 108; MIS n = 54 and OPEN n = 54). Modified Oswestry Disability Index (mODI) and back and leg pain were compared at baseline, 6–18 weeks, and 1-year post-operation. The number of patients meeting minimum clinically important difference (MCID) or minimum pain/disability at 1-year was compared. Results MIS approaches had less blood loss (decompression alone difference 100 mL, P = .002; with fusion difference 244 mL, P < .001) and shorter length of stay (LOS) (decompression alone difference 1.2 days, P = .008; with fusion difference 1.2 days, P = .026). MIS compared to OPEN decompression with fusion had less patients experiencing adverse events (AEs) (difference 13 patients, P = .007). The MIS decompression with fusion group had lower 1-year mODI (difference 14.5, 95% CI [7.5, 21.0], P < .001) and back pain (difference 1.6, 95% CI [.6, 2.7], P = .002) compared to OPEN. More patients in the MIS decompression with fusion group exceeded MCID at 1-year for mODI (MIS 75.9% vs OPEN 53.7%, P = .028) and back pain (MIS 85.2% vs OPEN 70.4%, P = .017). Conclusions MIS approaches were associated with more favorable outcomes for patients with diabetes undergoing decompression with fusion for LSS.

Download Full-text