Amar A Patel1, Matthew Zfass-Mendez2, Nathan H Lebwohl1, Michael Y Wang3, Barth A Green3, Allan D Levi3, Steven Vanni3, Seth K Williams4. 1. University of Miami, Miller School of Medicine Department of Orthopaedics Miami , FL. 2. Lenox Hill Hospital Department of Orthopaedics New York , New York. 3. University of Miami, Miller School of Medicine Department of Neurological Surgery Miami , FL. 4. University of Wisconsin School of Medicine and Public Health Department of Orthopedics and Rehabilitation Madison , WI.
Abstract
BACKGROUND: Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF). METHODS: Operative reports and perioperative data of patients undergoing single-level, primary open PLF (n=41), open PLIF/PLF (n=42), and MIS TLIF (n=71) were retrospectively evaluated. Patient demographics, operative blood loss, use of transfusion products, complications, and length of stay were tabulated. Patient data was controlled for age, BMI, and gender for statistical analysis. RESULTS: Patients undergoing open PLF and open PLIF/PLF respectively experienced a significantly higher blood loss (p<0.001), higher volume of blood transfusion (p<0.001), higher volume of cell saver transfusion (p<0.001), and more surgical complications (dural injury, wound infections, screw malposition) (p=0.02) than those undergoing MIS TLIF. There was no statistically significant difference in duration of hospital stay (p=0.11). CONCLUSIONS: MIS TLIF provides interbody fusion with less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques, but this did not influence length of hospital stay. MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement. LEVEL OF EVIDENCE: Level III, Therapeutic.
BACKGROUND: Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF). METHODS: Operative reports and perioperative data of patients undergoing single-level, primary open PLF (n=41), open PLIF/PLF (n=42), and MIS TLIF (n=71) were retrospectively evaluated. Patient demographics, operative blood loss, use of transfusion products, complications, and length of stay were tabulated. Patient data was controlled for age, BMI, and gender for statistical analysis. RESULTS:Patients undergoing open PLF and open PLIF/PLF respectively experienced a significantly higher blood loss (p<0.001), higher volume of blood transfusion (p<0.001), higher volume of cell saver transfusion (p<0.001), and more surgical complications (dural injury, wound infections, screw malposition) (p=0.02) than those undergoing MIS TLIF. There was no statistically significant difference in duration of hospital stay (p=0.11). CONCLUSIONS: MIS TLIF provides interbody fusion with less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques, but this did not influence length of hospital stay. MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement. LEVEL OF EVIDENCE: Level III, Therapeutic.
Authors: Chelsea E Canan; John A Myers; Roger Kirk Owens; Charles H Crawford; Mladen Djurasovic; Lauren O Burke; Kelly R Bratcher; Kathryn J McCarthy; Leah Y Carreon Journal: Spine (Phila Pa 1976) Date: 2013-04-15 Impact factor: 3.468
Authors: Chan Wearn Benedict Peng; Wai Mun Yue; Seng Yew Poh; William Yeo; Seang Beng Tan Journal: Spine (Phila Pa 1976) Date: 2009-06-01 Impact factor: 3.468
Authors: Sigurd H Berven; Vedat Deviren; Brian Mitchell; George Wahba; Serena S Hu; David S Bradford Journal: Neurosurg Clin N Am Date: 2007-04 Impact factor: 2.509
Authors: Saeed S Sadrameli; Vitaliy Davidov; Meng Huang; Jonathan J Lee; Srivathsan Ramesh; Jaime R Guerrero; Marcus S Wong; Zain Boghani; Adriana Ordonez; Sean M Barber; Todd W Trask; Andrew C Roeser; Paul J Holman Journal: J Spine Surg Date: 2020-09
Authors: Jorge Felipe Ramírez León; Álvaro Silva Ardila; José Gabriel Rugeles Ortíz; Carolina Ramírez Martínez; Gabriel Oswaldo Alonso Cuéllar; Jefferson Infante; Kai-Uwe Lewandrowski Journal: J Spine Surg Date: 2020-01
Authors: Ankur S Narain; Fady Y Hijji; Brittany E Haws; Benjamin Khechen; Krishna T Kudaravalli; Kelly H Yom; Kern Singh Journal: Int J Spine Surg Date: 2020-02-29
Authors: Remi M Ajiboye; Jayme C B Koltsov; Brian Karamian; Steven Swinford; Blake K Montgomery; Alexander Arzeno; Chason Ziino; Ivan Cheng Journal: J Spine Surg Date: 2019-12
Authors: Hai Le; Ryan Anderson; Eileen Phan; Joseph Wick; Joshua Barber; Rolando Roberto; Eric Klineberg; Yashar Javidan Journal: Global Spine J Date: 2020-06-22