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  • Minimally Invasive Transforaminal vs. Direct Lumbar Interbody Fusion: Effect on Return to Work and Narcotic Usage

    Final Number:

    Terence Verla MD MPH; Lona Winnegan NP-C; Nasser Yaghi MD; Ali Palejwala MD; Rory R. Mayer BS; Jacob Cherian MD; Ibrahim Omeis MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: Direct (DLIF) and transforaminal (TLIF) lumbar interbody fusions have been shown to produce satisfactory clinical outcomes with significant reduction in pain and functional disability. However, there is paucity of data comparing outcome measures of minimally invasive (MIS) TLIF and DLIF. The purpose of this study was to assess and compare time to return to work and narcotic usage in patients undergoing MIS DLIF and TLIF surgeries

    Methods: This is a retrospective study including patients who underwent minimally invasive, one level, transforaminal or direct lumbar interbody fusion. Only patients 18 years of age and older were included. We excluded patients with previous same level fusion surgery. Variables were collected from hospital records.

    Results: 26 patients were included (DLIF:12pts; TLIF:14pts). The average age was 58.08+/-8.64yrs (DLIF) and 55.43+/-13.58yrs (TLIF). Most of the patients were on acetaminophen-hydrocodone (50% DLIF, 29% TLIF). Overall, there was an improvement in VAS score but no significant difference in improvement between both cohorts (DLIF: 5.2/- 1.26 vs 5.3+/-2.2, p=0.94), Figure 1. There was no difference in hospital length of stay (DLIF: 3.7+/-1.75 days vs TLIF: 3.79+/-1.12 days, p=0.87). The duration of post-operative narcotic use was similar (DLIF: 2.92+/-3.58 mths; TLIF: 4.23+/-4.14 mths, p=0.44). Patients who underwent MIS TLIF had a significantly longer time to return to work (7.5 +/-5.5 mths) compared to DLIF (2.0+/-1.46mths, p=0.02), Figure 2.

    Conclusions: Both MIS TLIF and DLIF provide long-term improvement in pain and functional outcomes, with an overall reduction in post-operative narcotic requirement. This study shows that there is no difference in pain score improvement, hospital length of stay, and duration of narcotic usage post-operatively. There was a significantly longer time to return to work in the TLIF cohort compared to the DLIF patients.

    Patient Care: By selecting the right approach for the right patient based on pre-operative risk stratification, narcotic usage can be minimized and patients can return to work sooner.

    Learning Objectives: - DLIF and TLIF improve functional outcomes - Reduction in post-operative narcotic use - Longer return to work time with TLIF compared to DLIF


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