Introduction: Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss and minimize soft tissue damage with resultant reduced postoperative pain and disability.
Methods: We queried the national, multi-center, Quality Outcomes Database (QOD) registry from July 2014 through December 2015 for patients undergoing posterior lumbar fusion for grade I degenerative spondylolisthesis. We recorded baseline and 12-months patient reported outcomes. Multivariable regression models were fitted for length of hospital stay, 12-month patient reported outcomes and 90-day return to work, after adjusting for an array of preoperative and surgical variables.
Results: A total of 345 patients (Open-254, MIS-91) were identified in the QOD. Follow-up rate at 12 months was 84% (Open-83.5%, MIS-85%). Overall, baseline patient demographics, comorbidities and clinical characteristics were similarly distributed between the two cohorts. Two hundred fifty seven patients underwent 1-level fusion (Open-181, MIS-76) and eighty eight patients underwent 2-level fusion (Open-73, MIS-15). MIS was associated with significantly lower mean intraoperative blood loss (156 vs 355 ml, p< .001) and slightly longer operative time (Open-200 vs. MIS-224 minutes, p=0.045). No difference was detected with regards to average length of stay (Open-3.51 days vs. MIS-3.34 days, p=0.44). On risk-adjusted analysis, patients undergoing an MIS approach had significantly lower 12-month NRS-LP scores (OR 0.53, 95% C.I. 0.31-0.86, p=0.011). Open versus minimally invasive approach was not significant for length of stay, 90-day return to work as well as 12-month ODI, EQ-5D, NRS-BP and satisfaction.
Conclusions: Patients undergoing minimally invasive lumbar fusion for grade I degenerative spondylolisthesis had significantly NRS-LP scores at 12-months; however no difference was detected with regards to the other patient reported outcomes, length of stay and 90-day return to work. Longer follow-up functional outcome scores are needed to provide further insight.
Patient Care: By identifying the optimal surgical management for patients with degenerative lumbar spondylolisthesis.
Learning Objectives: By the end of this session, the participants should be able to discuss the effectiveness of open and minimally invasive spinal for lumbar spondylolisthesis and compare the two approaches with regards to surgical and functional outcomes.