Fast tracking lumbar fusion: reducing costs with an ERAS program for minimally invasive transforaminal lumbar interbody fusion

2017 ◽  
Vol 2 ◽  
pp. 175-175
Author(s):  
Stephen G. Bowden ◽  
Khoi D. Than
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Fast Tracking ◽  
Reducing Costs

scholarly journals Minimally Invasive Transforaminal Lumbar Interbody Fusion Ameliorates Persistent Pain After Lumbar Fusion Surgery

2020 ◽  
Author(s):  
Jun Li ◽  
Kai Liu ◽  
Li Yang ◽  
DEGUO WANG
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Persistent Pain ◽  
Lumbar Interbody Fusion ◽  
Fusion Surgery ◽  
Drainage Fluid ◽  
Lumbar Fusion Surgery ◽  
Degenerative Lumbar Diseases

Abstract Background: Approximately 4-20% patients with degenerative lumbar diseases showed persistent pain after lumbar fusion surgery that may develop into failed back surgery syndrome (FBSS), and this persistent pain may be related to the postoperative increased release of inflammatory mediators. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) can obviously reduce the intraoperative soft tissue trauma. The aim of this study is to investigate the persistent pain in the patients with degenerative lumbar diseases undergoing MIS-TLIF compared with conventional‑invasive TLIF. Material and methods: This study retrospectively included 146 patients (MIS-TLIF vs. conventional‑invasive TLIF: 56 vs. 90), and the incidence of persistent pain were evaluated. Furthermore, inflammation related markers in both blood and drainage fluid samples, including white blood cell (WBC) count, C-reactive protein (CRP), creatine kinase (CK), interleukin-6 (IL-6) and IL-1β, were tested before and after operation. Results: Significantly larger number of patients undergoing conventional‑invasive TLIF showed postoperative persistent pain compared to those undergoing MIS-TLIF (4/56, 7.1% vs. 20/90, 22.2%; P < 0.05). In both treatment groups, the patients with postoperative persistent pain showed increased IL-6 and IL-1β in drainage fluid, as well as increased IL-6 in blood samples (P < 0.05), and there is significant correlation between the inflammation markers in drainage fluid and the extent of postoperative persistent pain in patients with postoperative persistent pain (P < 0.05). Conclusions: Local inflammatory substance accumulation may be potential cause for postoperative persistent pain, and MIS-TLIF may reduce this inflammatory accumulation at the surgical site and subsequently reduce the risk of persistent pain.

scholarly journals COMPLICATIONS IN THREE LUMBAR ARTHRODESIS TECHNIQUES: TLIF, MITLIF, PLIF

2017 ◽  
Vol 16 (1) ◽  
pp. 74-77 ◽  
Author(s):  
AVELINO AGUILAR MERLO ◽  
RICARDO ROJAS BECERRIL ◽  
MARIO LORETO LUCAS ◽  
SHEILA PATRICIA VÁZQUEZ ARTEAGA
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Spine Surgeon ◽  
Lumbar Spondylolisthesis ◽  
Incidental Durotomy ◽  
Invasive Techniques

ABSTRACT Objective: To determine that minimally invasive transforaminal lumbar fusion has fewer complications of chronic lumbar instability compared with traditional open techniques. Methods: Retrospective, observational study of 132 patients with grade I and II lumbar spondylolisthesis with advanced disc degeneration. Forty-five patients operated by minimally invasive transforaminal lumbar interbody fusion (MITLIF), 45 patients operated by posterior lumbar interbody fusion (PLIF) and 42 patients operated by open transforaminal lumbar interbody fusion (TLIF). Results: Four patients had incidental durotomy, two in the TLIF group and two in the PLIF group. There were no cases of incidental durotomy in the minimally invasive transforaminal access group. No patient in the study presented an inadequate screw position, the lowest mean bleeding occurred in the group of minimally invasive instrumentation of one and two levels. There were 6.6% of infections for PLIF group and none in the other two groups. Conclusions: Arthrodesis techniques are not free of complications, however, the frequency is lower with minimally invasive techniques. Nonetheless, it requires training and does not dispense the need for a learning curve for the spine surgeon compared to open lumbar fusion techniques.

scholarly journals Minimally invasive transforaminal lumbar interbody fusion: indications, technique, and complications

2006 ◽  
Vol 20 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Langston T. Holly ◽  
James D. Schwender ◽  
David P. Rouben ◽  
Kevin T. Foley
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Radicular Pain ◽  
Low Back ◽  
Lumbar Interbody Fusion ◽  
Disc Disease ◽  
Dorsal Approach ◽  
Tubular Retractor

✓The authors provide an overview of the minimally invasive transforaminal lumbar interbody fusion (TLIF) procedure including indications, technique, and complications. This novel technique is a method of achieving circumferential lumbar fusion using a unilateral dorsal approach. Minimally invasive TLIF uses a tubular retractor that is inserted via a muscle-dilating exposure, thereby minimizing the approach-related morbidity. This procedure is ideal for refractory mechanical low-back and radicular pain associated with spondylolisthesis, degenerative disc disease, and recurrent disc herniation. The authors' clinical experience and review of the medical literature indicate that TLIF can be effectively and safely performed in a minimally invasive fashion.

Paramedian approach for transforaminal lumbar interbody fusion with unilateral pedicle screw fixation

2006 ◽  
Vol 20 (3) ◽  
pp. 1-5 ◽  
Author(s):  
Jonathan Tuttle ◽  
Ahmed Shakir ◽  
Haroon Fiaz Choudhri
Keyword(s):  
Minimally Invasive ◽  
Patient Population ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Minimally Invasive Techniques ◽  
Previous Surgery ◽  
Unilateral Pedicle Screw ◽  
Invasive Techniques

✓ Lumbar fusion is a commonly performed procedure for a variety of pathological conditions, and it is frequently used in the treatment of degenerative lumbar instability that is refractory to medical management. Pedicle screws and interbody devices have been used for internal fixation to promote arthrodesis, prevent nonunion, and facilitate early mobilization. Recently, attempts have been made to reduce the morbidity associated with lumbar fusion by using a variety of minimally invasive techniques. Many minimally invasive lumbar fusion procedures require specialized retractors, implants, image guidance systems, or insertion instruments. Other minimally invasive techniques are primarily applied to an ideal patient population (thin, healthy, and with no previous surgery). The authors describe their experience with a paramedian approach for minimally invasive transforaminal lumbar interbody fusion (TLIF) with unilateral pedicle screw (PS) fixation. This procedure requires only standard implants, instruments, and retractors, with direct visualization for all aspects of the procedure. The authors describe encouraging early results in a challenging patient population in which there was a high incidence of obesity, medical comorbidities, and previous surgery at the same level. The paramedian approach for TLIF performed using unilateral lumbar PSs has yielded successful outcomes in this series of 47 patients, and further study of this technique may help define its role as a minimally invasive procedure for spinal fusion.

Reduced Acute Care Costs With the ERAS® Minimally Invasive Transforaminal Lumbar Interbody Fusion Compared With Conventional Minimally Invasive Transforaminal Lumbar Interbody Fusion

Neurosurgery ◽  
2017 ◽  
Vol 83 (4) ◽  
pp. 827-834 ◽  
Author(s):  
Michael Y Wang ◽  
Hsuan Kan Chang ◽  
Jay Grossman
Keyword(s):  
Minimally Invasive ◽  
Acute Care ◽  
Fast Track ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Clinical Results ◽  
Lumbar Interbody Fusion ◽  
Fast Track Surgery ◽  
Hospitalization Costs

Abstract BACKGROUND Enhancing Recovery After Surgery (ERAS®) programs have been widely adopted throughout the world, but not in spinal surgery. In this report, we review the implementation of a “fast track” surgery for lumbar fusion and its effect on acute care hospitalization costs. OBJECTIVE To determine if a “fast track” surgery methodology results in acute care cost savings. METHODS Thirty-eight consecutive ERAS patients were compared with patients undergoing conventional minimally invasive transforaminal lumbar interbody fusion. Differences between these groups included the use of endoscopic decompression, injections of liposomal bupivacaine, and performing the surgery under sedation in the ERAS® group. RESULTS Patients had similar medical comorbidities (2.02 vs 2 for ERAS® and comparator groups, respectively; P = .458). Body mass index was similar (26.5 vs 27.0; P = .329). ERAS® patients were older (65 vs 59 yr, P = .031). Both groups had excellent clinical results with an improvement of 23% and 24%, respectively. Intraoperative blood loss was less (68 ± 31 cc vs 231 ± 73, P &lt; 0.001). Length of stay was also less with ERAS® surgery, at a mean of 1.23 ± 0.8 d vs 3.9 ± 1.1 d (P = 0.009). When comparing ERAS® surgery to standard minimally invasive transforaminal lumbar interbody fusion, the total cost for the acute care hospitalization was $19 212 vs $22 656, respectively (P &lt; 0.001). This reflected an average of $3444 in savings, which was a 15.2% reduction. CONCLUSION ERAS® programs for spinal fusion surgery have the potential to reduce the costs of acute care. This is made possible by leveraging less invasive interventions to minimize soft tissue damage.

Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion

2020 ◽  
Vol 32 (1) ◽  
pp. 31-35
Author(s):  
Mladen Djurasovic ◽  
Jeffrey L. Gum ◽  
Charles H. Crawford ◽  
Kirk Owens ◽  
Morgan Brown ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Smoking Status ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Direct Costs ◽  
Lumbar Interbody Fusion ◽  
Related Quality ◽  
Health Related

OBJECTIVEThe midline transforaminal lumbar interbody fusion (MIDLIF) using cortical screw fixation is a novel, minimally invasive procedure that may offer enhanced recovery over traditional open transforaminal lumbar interbody fusion (TLIF). Little information is available regarding the comparative cost-effectiveness of the MIDLIF over conventional TLIF. The purpose of this study was to compare cost-effectiveness of minimally invasive MIDLIF with open TLIF.METHODSFrom a prospective, multisurgeon, surgical database, a consecutive series of patients undergoing 1- or 2-level MIDLIF for degenerative lumbar conditions was identified and propensity matched to patients undergoing TLIF based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists Physical Status Classification System (ASA) class, and levels fused. Direct costs at 1 year were collected, including costs associated with the index surgical visit as well as costs associated with readmission. Improvement in health-related quality of life was measured using EQ-5D and SF-6D.RESULTSOf 214 and 181 patients undergoing MIDLIF and TLIF, respectively, 33 cases in each cohort were successfully propensity matched. Consistent with propensity matching, there was no difference in age, sex, BMI, diagnosis, ASA class, smoking status, or levels fused. Spondylolisthesis was the most common indication for surgery in both cohorts. Variable direct costs at 1 year were $2493 lower in the MIDLIF group than in the open TLIF group (mean $15,867 vs $17,612, p = 0.073). There was no difference in implant (p = 0.193) or biologics (p = 0.145) cost, but blood utilization (p = 0.015), operating room supplies (p < 0.001), hospital room and board (p < 0.001), pharmacy (p = 0.010), laboratory (p = 0.004), and physical therapy (p = 0.009) costs were all significantly lower in the MIDLIF group. Additionally, the mean length of stay was decreased for MIDLIF as well (3.21 vs 4.02 days, p = 0.05). The EQ-5D gain at 1 year was 0.156 for MIDLIF and 0.141 for open TLIF (p = 0.821). The SF-6D gain at 1 year was 0.071 for MIDLIF and 0.057 for open TLIF (p = 0.551).CONCLUSIONSCompared with patients undergoing traditional open TLIF, those undergoing MIDLIF have similar 1-year gains in health-related quality of life, with total direct costs that are $2493 lower. Although the findings were not statistically significant, minimally invasive MIDLIF showed improved cost-effectiveness at 1 year compared with open TLIF.

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