Comparative analysis of perioperative surgical site infection after minimally invasive versus open posterior/transforaminal lumbar interbody fusion: analysis of hospital billing and discharge data from 5170 patients

2011 ◽  
Vol 14 (6) ◽  
pp. 771-778 ◽  
Author(s):  
Matthew J. McGirt ◽  
Scott L. Parker ◽  
Jason Lerner ◽  
Luella Engelhart ◽  
Tyler Knight ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Site Infection ◽  
Direct Cost ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Site Infection ◽  
Patient Morbidity ◽  
Significant Difference ◽  
Level Fusion

Object Surgical site infection (SSI) after lumbar fusion results in significant patient morbidity and associated medical resource utilization. Minimally invasive (MI) techniques for posterior/transforaminal lumbar interbody fusion (P/TLIF) were introduced with the goals of smaller wounds, less tissue trauma, reduced blood loss, and quicker postoperative recovery, while maintaining comparable surgical results. Studies with sufficient power to directly compare the incidence of SSI following MI versus open P/TLIF procedures have been lacking. Furthermore, the direct medical cost associated with the treatment of SSI following the P/TLIF procedure is poorly understood and has not been adequately assessed. Thus, the aim in the present study was to determine the incidence of perioperative SSI in patients undergoing MI versus open P/TLIF and the direct hospital cost associated with the diagnosis and management of SSI after P/TLIF as reported in a large administrative database. Methods The authors retrospectively reviewed hospital discharge and billing records from the Premier Perspective Database for 2003 to 2009 to identify patients undergoing 1- or 2-level MI or open P/TLIF for lumbar spondylotic disease, disc degeneration, or spondylolisthesis. The ICD-9-CM procedure codes were used to identify patients undergoing P/TLIF and those experiencing SSI. Infection-related costs were obtained from the total costs incurred by the hospital for SSI-related care provided during inpatient or hospital outpatient encounters. Results Five thousand one hundred seventy patients undergoing P/TLIF were identified. Demographic profiles, including the Charlson Comorbidity Index, were similar between MI and open cohorts. Overall, 292 patients (5.6%) experienced an SSI with a mean direct cost of $15,817 per SSI. For 1-level MI versus open P/TLIF, the incidence of SSI (38 [4.5%] vs 77 [4.8%], p = 0.77) and the mean SSI-associated cost per P/TLIF ($684 vs $724, p = 0.680) were similar. For 2-level MI versus open P/TLIF, the incidence of SSI (27 [4.6%] vs 150 [7.0%], p = 0.037) and mean SSI-associated cost per P/TLIF ($756 vs $1140, p = 0.030) were both significantly lower among MI-treated patients. In a multivariate model that accounted for differences in demographics and patient severity, open fusion was associated with a strong trend of increased incidence of SSI as compared with MI fusion (OR 1.469, 95% CI 0.959–2.250). Conclusions In this multihospital study, the MI technique was associated with a decreased incidence of perioperative SSI and a direct cost savings of $38,400 per 100 P/TLIF procedure when used in 2-level fusion. There was no significant difference in the incidence of SSIs between the open and MI cohorts for 1-level fusion procedures. The results of this study provide further evidence of the reduced patient morbidity and health care costs associated with MI P/TLIF.

Minimally invasive transforaminal lumbar interbody fusion with ipsilateral pedicle screw and contralateral facet screw fixation

2005 ◽  
Vol 3 (3) ◽  
pp. 218-223 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Minimally Invasive ◽  
Pedicle Screw ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Content Type ◽  
The Mean ◽  
Level Fusion ◽  
Fine Print

Object. The purpose of this study was to introduce a minimally invasive transforaminal lumbar interbody fusion (TLIF) technique that involves ipsilateral pedicle screw (PS) and contralateral facet screw (FS) fixation. Methods. Eight men and 15 women (mean age 59.5 years, range 48–68) underwent the aforementioned TLIF procedure for degenerative spondylolisthesis and uni- or bilateral radiculopathy. Twenty-two patients underwent one-level fusion and one patient two-level fusion (L4—S1). In all cases the various procedures were undertaken via one small incision. There were no intraoperative complications. The mean estimated blood loss (EBL) was 310 ml, and the mean operative time was 150 minutes in cases of one-level fusion. The follow-up period ranged from 13 to 28 months (mean 19 months). The mean Numeric Rating Scale score reflected improvement-reductions from 7.5 (back pain) and 7.4 (leg pain) to 2.3 and 0.7, respectively (p < 0.0001). The mean Oswestry Disability Index (ODI) scores also reflected improved status (ODI of 33.1 before the surgery to 7.6 after the surgery; p < 0.0001). Examination indicated that 22 of 24 fusion sites exhibited osseous union. At the last follow-up examination, satisfactory outcomes were observed in 21 out of 23 patients. Conclusions. The TLIF with ipsilateral PS and contralateral FS fixation has the advantages over the conventional TLIF of reduced EBL and diminished soft-tissue injury.

Biomechanical evaluation of different asymmetrical posterior stabilization methods for minimally invasive transforaminal lumbar interbody fusion

2008 ◽  
Vol 9 (4) ◽  
pp. 363-371 ◽  
Author(s):  
Philipp Schleicher ◽  
Paavo Beth ◽  
Andreas Ottenbacher ◽  
Robert Pflugmacher ◽  
Matti Scholz ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Soft Tissues ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Interference Screw ◽  
Surgical Trauma ◽  
Lumbar Interbody Fusion ◽  
Posterior Stabilization ◽  
Stabilization Methods ◽  
Significant Difference

Object Beside several other advantages, the transforaminal approach for lumbar interbody fusion offers the possibility of reducing surgical trauma by limiting the approach to only 1 side. This requires posterior stabilization methods, which are applied without the need to damage contralateral muscles and soft tissues. The goal in this study was to compare different posterior stabilization methods for minimally invasive transforaminal lumbar interbody fusion (TLIF) biomechanically. Methods Stiffness testing was performed in 8 fresh-frozen human cadaveric lumbar spine motion segments, including the following sequentially tested configurations: 1) native motion segment; 2) TLIF and bilateral pedicle screw (PS) construct; 3) TLIF and ipsilateral PS construct; 4) TLIF and ipsilateral PSs plus contralateral translaminar facet screws according to the Magerl technique; and 5) TLIF and ipsilateral PSs plus contralateral lumbar facet interference screw (LFIS). Results In extension, the unilateral range of motion (uROM) and elastic zone (EZ) were significantly lower than native motion segments for bilateral PS and LFIS. There were no significant differences among the different stabilization methods. In flexion, uROM and EZ were significantly lower than the native segment in the spines treated with bilateral PSs and translaminar facet screws. The LFIS differed from the native segment in EZ only. Again, there were no significant differences between the different posterior stabilization methods. In lateral bending, the EZ of spines treated with uni- and bilateral PS differed significantly. There were no additional significant differences. In rotation, the stiffness values of bilateral PS were significantly higher than native, unilateral PS, and LFIS. The comparison between ipsi- and bilateral PS showed a tendency, but not a significant difference for uROM and EZ. There was no statistically significant evidence that the TLIF method led to an asymmetrical motion behavior in our study. Conclusions Bilateral PS augmentation offers significantly more stability than unilateral PSs in the majority of the test modes. There was no significant difference between the other tested methods. All tested stabilization methods could achieve at least the stability of the native segment.

scholarly journals Evaluations of minimally invasive transforaminal lumbar interbody fusion performed with rhBMP-2

2019 ◽  
Author(s):  
Bin Lv ◽  
Yuting Hou ◽  
Xiang Jin ◽  
Dan Luo ◽  
Lei Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Data ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Patient Reported ◽  
Cage Subsidence

Abstract Background: The combination of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and recombinant human bone morphogenetic protein 2 (rhBMP-2) is widely used for its advantage of rapid recovery and improved bone fusion. However, no previous study has reported the synergistic effect of MIS-TLIF with rhBMP-2 in patients with degenerative lumbar disease (DLD). Objective: To investigate the radiographic and patient-reported outcomes (PROs) in patients with DLD who underwent MIS-TLIF with and without a low dose of rhBMP-2. Methods: We retrospectively reviewed 48 patients treated with MIS-TLIF from 2013 to 2016. The patients were classified into the rhBMP-2 group (n = 25) and non-rhBMP-2 group (n = 23). Fusion-related parameters were measured before and after the operation. Clinical data included the numeric rating scale (NRS) score, Japanese Orthopedic Association (JOA) scores, and the MOS 36-item short form health survey (SF-36) score, which were documented to evaluate the effect of surgery. Results: In the 48 patients who underwent MIS-TLIF, the operated disc was predominantly at the L4/5 and L5/S1 levels. ADH, MDH, and PDH increased significantly in both groups after surgery (P < 0.05). FH improved in the rhBMP-2 group, but not in the non-rhBMP-2 group. There was no obvious improvement in SA in both groups. Furthermore, the SL showed a significant difference in both groups and a significant improvement over the baseline. The LL showed significant improvement in the two groups at the early follow-up (P < 0.05), but the improvement did not persist. Cage subsidence had no significant effect on different subsidence grades. In addition, no differences in cage subsidence were observed in different types of modic change (MC), except for MC 0 in both groups. There was no difference in PROs even though all clinical outcomes improved significantly during the postoperative follow-up period in both groups. Conclusion: MIS-TLIF with the low doses of rhBMP-2 resulted in an improvement in radiographic and clinical results, but not a longer-lasting restoration for radiographic outcomes. Cage subsidence is not associated with the MC. Further, our clinical data demonstrated no difference between both groups.

Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Banana-Shaped and Straight Cages: Radiological and Clinical Results from a Prospective Randomized Clinical Trial

Neurosurgery ◽  
2017 ◽  
Vol 82 (3) ◽  
pp. 289-298 ◽  
Author(s):  
Won-Suh Choi ◽  
Jin-Sung Kim ◽  
Jung-Woo Hur ◽  
Ji-Hoon Seong
Keyword(s):  
Minimally Invasive ◽  
Visual Analog Scale ◽  
Oswestry Disability Index ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Disc Height ◽  
Lumbar Interbody Fusion ◽  
Analog Scale ◽  
Significant Difference ◽  
Cage Group

Abstract BACKGROUND In minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), cage type and position play important roles in fusion achievement and sagittal alignment correction. However, no prospective randomized comparison of the results using different types of cage has been reported to date. OBJECTIVE To compare the radiological and clinical outcomes of unilateral MIS-TLIF using 2 types of cage. METHODS All candidates for single-level MIS-TLIF were randomized into banana-shaped cage and straight-cage groups. Plain radiographs and computed tomography scans were used for assessment of cage positions, fusion status, disc height, segmental lordotic angle, cage subsidence, and pelvic parameters. Clinical outcome was assessed using visual analog scale and Oswestry Disability Index scores. RESULTS Forty-four and 40 consecutive patients were operated on using banana-shaped and straight cages, respectively. Cage position was more anterior and lateral in the straight-cage group and more medial and posterior in the banana-shaped cage group. Solid fusion was achieved in 95.2% and 96.6% of the 2 groups, respectively, at 12 mo. The change in disc height and segmental lordotic angle postoperatively was significantly greater in the banana-shaped cage group. The incidence of subsidence during follow-up was significantly higher in the banana-shaped cage group (P &lt; .04). Clinically, the visual analog scale and Oswestry Disability Index scores decreased significantly after surgery in both groups, with no significant difference between the groups. CONCLUSION Our preliminary outcomes suggest that the subsidence rate may be higher using banana-shaped cages in MIS-TLIF, possibly due to their more medial final position.

scholarly journals Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
You-Di Xue ◽  
Wen-Bo Diao ◽  
Chao Ma ◽  
Jie Li
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Degenerative Disease ◽  
Lumbar Interbody Fusion ◽  
Lumbar Degenerative Disease ◽  
Imaging Results ◽  
Significant Difference

Abstract Purpose This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). Materials and methods We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. Results There was no significant difference between the two groups in operative time and complication rate. The estimated blood loss and the length of hospital stay in the PETLIF group were significantly better than those in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. Conclusions Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.

scholarly journals Spinal Subdural Abscess following Transforaminal Lumbar Interbody Fusion

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Isamu Miura ◽  
Motoo Kubota ◽  
Oji Momosaki ◽  
Kento Takebayashi ◽  
Takakazu Kawamata ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Interbody Fusion ◽  
Fluid Collection ◽  
Cauda Equina ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Balloon Kyphoplasty ◽  
Lumbar Interbody Fusion ◽  
Site Infection ◽  
Lumbar Vertebral Fracture ◽  
Subdural Abscess

Spinal subdural abscesses are rare lesions. We report the case of surgical site infection complicated with meningitis and rapidly progressive spinal subdural abscess caused by P. aeruginosa following transforaminal lumbar interbody fusion (TLIF). A 72-year-old woman was admitted to our hospital complaining of drop foot syndrome and sciatica caused by stenosis of the L5/6 intervertebral foramen accompanied by L5 lumbar vertebral fracture. Accordingly, TLIF of L5-L6 and balloon kyphoplasty of L5 were performed. On the 3rd postoperative day (POD), she was diagnosed with surgical site infection complicated with bacterial meningitis. Subcutaneous fluid, blood, and cerebrospinal fluid cultures indicated P. aeruginosa. On the 7th POD, a repeat MRI showed a large dorsal fluid collection consistent with a subdural infection and massive cauda equina compression. We performed debridement and instrument removal and found a dural laceration that was not observed during the first operation. An intraoperative insensible dural laceration may cause bacteria intrusion into the subdural space.

scholarly journals Effect of Cage Type on Immediate Postoperative Radiographic Outcomes in Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Avani Vaishnav ◽  
Joshua Wright-Chisem ◽  
Michael Steinhaus ◽  
Steven Mcanany ◽  
Sravisht Iyer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Expandable Cage ◽  
Radiographic Outcomes ◽  
Radiographic Parameters ◽  
Significant Difference ◽  
Segmental Lordosis ◽  
Foraminal Height

Abstract INTRODUCTION The type of cage used in minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) can impact several goals of the procedure, including optimizing disc and foraminal height, interbody fusion, and sagittal balance. METHODS Segmental lordosis (SL), lumbar lordosis (LL), posterior disc height (PDH) were compared using upright lateral radiographs obtained pre- and postoperatively. Impact of demographic (age, sex, and BMI), preoperative radiographic (SL, LL, and PDH) and operative factors (cage-type, cage-width, and cage-position) on radiographic outcomes were assessed. RESULTS Of the 154 patients included, 55 received a static oblique, 63 a static articulating, and 36 an expandable articulating cage. There was no significant difference in SL pre- (P = .389) or postoperatively (P = .613). A difference was seen in change in SL (P = .023), with the expandable articulating cage showing the greatest increase, and an improvement from pre- to postoperatively (P = .033). A significant difference was seen in change in LL (P = .050), with the static oblique and expandable articulating groups maintaining LL (P = .238 and P = .873), but the static articulating group showing decrease in LL (P < .0001). There was a significant difference in PDH pre- and postoperatively (P < .0001 and P = .045). All three cages increased in PDH (P < .0001), with the expandable articulating cage showing the greatest increase (P = .009). Regressions showed that preoperative SL was the only significant predictor of postoperative SL (P < .0001; R2 = 0.418) and change in SL (P < .0001; R2 = 0.247); preoperative LL of postoperative LL (P < .0001; R2 = 0.609) and change in LL (P < .0001; R2 = 0.227); and preoperative PDH of postoperative PDH (P < .0001; R2 = 0.360) and change in PDH (P < .0001; R2 = 0.299). Cage-type, cage-position, and cage-width were not significant predictors of radiographic parameters. CONCLUSION Preoperative radiographic parameters were predictors of postoperative parameters. While the static cages maintained SL, the expandable cage increased SL. The expandable cage had the lowest preoperative PDH, likely reflective of the expandable technology allowing for cage-insertion even in collapsed disc spaces. The expandable articulating cage demonstrated benefit in increasing SL, maintaining LL and causing the greatest increase in PDH.

scholarly journals Zgodnje prednosti manj invazivne transforaminalne zatrditve ledvene hrbtenice v primerjavi s klasično odprto metodo

2015 ◽  
Vol 84 (5) ◽  
Author(s):  
Gregor Rečnik ◽  
Milko Milčič ◽  
Samo Karl Fokter ◽  
Nino Mirnik ◽  
Andrej Moličnik ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Invasive Technique ◽  
Open Approach ◽  
Lumbar Interbody Fusion ◽  
Surgical Time ◽  
Lower Blood ◽  
Significant Difference

AbstractBackgroundLumbar interbody fusion is a standard operative procedure in orthopedic spine surgery. Morphological and functional changes in the multifidus muscle after an open procedure have led to the development of a minimally invasive technique, after which no such muscle changes were observed. MethodsSixty-four patients, with clinical and radiological criteria for one-level transforaminal lumbar interbody fusion were enrolled in our prospective randomized study between December 2011 and March 2014. They were randomized into two groups: open approach (33 patients) vs. minimally invasive approach (31 patients); one patient was excluded from each group due to postoperative complications. Independent samples T-test was used to compare average values of increase in creatin kinase (CK), which is an enzymatic marker of muscle injury, average surgical time, loss of blood during and after surgery, back pain according to the Visual Analogue Scale (VAS) and day of discharge from the hospital. ResultsStatistically important (P< 0.001) lower blood loss (188 ml vs. 527 ml total), less CK increase (15 ukat/L vs. 29 ukat/L), lower VAS score after surgery (7.3 vs. 8.7) and earlier discharge from the hospital (3.5 days vs. 5.2 days) were observed in the minimally invasive transforaminal lumbar interbody fusion group. No significant difference in average surgical time was recorded. Conclusions Our results suggest, that minimally invasive transforaminal lumbar interbody fusion causes is associated with less muscle damage, lower blood loss, less post surgical pain and faster early rehabilitation, which is in accordance with previous studies.

Outcome following unilateral versus bilateral instrumentation in patients undergoing minimally invasive transforaminal lumbar interbody fusion: a single-center randomized prospective study

2013 ◽  
Vol 35 (2) ◽  
pp. E13 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Alexander T. Nixon ◽  
Cort D. Lawton ◽  
Albert P. Wong ◽  
Zachary A. Smith ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Interbody Fusion ◽  
Short Form ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Lumbar Interbody Fusion ◽  
Significant Difference ◽  
Lost To Follow Up

Object Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is used to treat a wide variety of lumbar degenerative disorders. Although there are some reports showing efficacy of unilateral instrumentation during MIS-TLIF, a controlled randomized prospective study has not been done. Methods Forty-one patients were randomly assigned to receive either bilateral or unilateral instrumentation following 1-level unilateral MIS-TLIF. Four patients were lost to follow-up in the unilateral group and 1 patient was lost to follow-up in the bilateral group. Preoperative and postoperative scores on a visual analog scale (VAS) for back pain and leg pain (VAS-BP and VAS-LP, respectively), Oswestry Disability Index (ODI), and 36-Item Short Form Healthy Survey version 2 (SF-36v2) were collected. Additionally, preoperative and postoperative segmental Cobb angles and radiographic evidence of fusion were analyzed. Results There was no statistically significant difference in baseline demographic characteristics between the 2 groups. The VAS-BP, VAS-LP, ODI, and SF-36v2 physical component scores improved significantly after surgery in both groups (p < 0.05); there was no statistically significant between-groups difference in the degree of improvement. Blood loss was significantly higher in the bilateral instrumentation group and hospital stay was longer in the unilateral instrumentation group. There was no statistically significant between-groups difference with respect to change in segmental lordosis or fusion rate. The average duration of follow-up was 12.4 months for the bilateral instrumentation group and 11.4 months for the unilateral instrumentation group. Conclusions Clinical and radiographic outcomes of unilateral and bilateral instrumentation for unilateral MISTLIF are similar 1 year after surgery.

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