Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion: a review.
ABSTRACT Low back pain is one of the most prevalent and disabling musculoskeletal conditions affecting the working population in the United States. Informed, shared decision making among patients, clinicians, and case managers about treatment options for chronic low back pain-including the role of spinal fusion where medically necessary-can have a meaningful impact on return to work, normal function, and economic outcomes. Minimally invasive techniques for lumbar spinal fusion, including transforaminal lumbar interbody fusion (MIS TLIF) have recently been introduced with the goal of smaller operative wounds, less tissue trauma, and faster postoperative recovery when compared with open fusion. Although similar long-term clinical outcomes have been reported for MIS TLIF and open TLIF, the relative merits with respect to workplace productivity have not been comprehensively investigated. Time to return to work and narcotic independence after MIS TLIF and open TLIF are important parameters that may affect overall workplace productivity, and as such are the focus of this study.
This study was performed via a review of the literature.
We performed a systematic literature review to identify all published articles that reported on the postoperative outcomes of patients, as assessed by return to work or narcotic independence status or both, following MIS TLIF or open TLIF. A cumulative comparison was made for all included MIS TLIF versus open TLIF surgeries.
Seventy-four published studies reported postoperative outcomes following MIS TLIF or open TLIF; only five (6.8%) studies directly described time to return to work or duration of narcotic use postoperatively or both, and were therefore included into the analysis of this review. Four studies in the published literature describe time to return to work following MIS TLIF or open TLIF, and two studies describe time to narcotic independence. Overall, the reviewed literature suggests that MIS TLIF may be associated with an accelerated time to narcotic independence and return to work versus open TLIF.
There are limited data regarding time to return to work and duration of postoperative narcotic use following TLIF for low back pain. The available data appear to suggest that MIS TLIF may be associated with accelerated return to work and narcotic independence compared with open TLIF. Further analysis will be necessary to quantify the impact of MIS TLIF on workplace productivity and the indirect costs borne by patients and employers. Such information will be of value to case managers, disability managers, employers, patients, and clinicians aligned on reducing morbidity and hastening return to normal function.
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ABSTRACT: Study Design/Setting. This was a prospective clinical study that took place in an outpatient spine clinic.Objective. To demonstrate the short/long-term outcomes from a large cohort of patients undergoing minimally invasive transforaminal lumbar interbody fusion (MITLIF).Summary of Background Data. Long-term prospective outcomes in patients undergoing minimally invasive spinal fusion for debilitating back pain has not been well studied.Methods. Presenting diagnosis was determined from clinical findings and radiographic (X-ray, MRI, CT-scan) evaluations pre-operatively. Patients were assessed with outcome measures pre-operatively, and post-operatively at two weeks, three months, six months, twelve months, 24 months, and annually 2-7 years (mean follow-up: 47 months) final follow-up. The rate of post-operative complications and reoperations at the initial level of MITLIF and adjacent level (s) were followed. Fusion rates were assessed blinded and independently by radiograph.Results. VAS scores decreased significantly from 7.0 pre-operatively to 3.5 at mean 47-month follow-up. ODI scores declined from 43.1 pre-operatively to 28.2 at mean 47-month follow-up. SF-36 mental component scores (MCS) increased from 43.8 pre-operatively to 49.7 at 47-month follow-up. SF-36 physical component scores (PCS) increased from 30.6 pre-operatively to 39.6 at 47-month follow-up. (p-value<0.05)Conclusion. This prospectively collected outcomes study shows long-term statistically significant clinical outcomes improvement after MITLIF in patients with clinically symptomatic spondylolisthesis and degenerative disk disease with or without stenosis. MITLIF resulted in a high rate of spinal fusion and very low rate of interbody fusion failure and/or adjacent segment disease requiring re-operation while reducing post-operative complications.Spine 10/2013; 39(3). DOI:10.1097/BRS.0000000000000078 · 2.45 Impact Factor
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ABSTRACT: Transforaminal lumbar interbody fusion (TLIF) has become one of the most widely used procedures for lumbar spinal disorders. However, it is still unclear whether TLIF with unilateral pedicle screw (PS) fixation is as effective as that with bilateral PS fixation. We performed a meta-analysis of the literatures and aimed to gain a better understanding of whether TLIF with unilateral PS fixation was safe and effective for lumbar diseases. We systematically searched Ovid, Springer, and Medline databases for relevant randomized controlled trials (RCTs) that compared the clinical and radiological outcomes of unilateral versus bilateral PS fixation in TLIF. Risk of bias in included studies was assessed using the Cochrane Risk of Bias tool. We generated pooled risk ratios or weighted mean differences across studies. According to our predefined inclusion criteria, seven RCTs with a total of 441 patients were included in this study. Baseline characteristics were similar between the unilateral and bilateral groups. Our meta-analysis showed that no significant difference was detected between the two groups in terms of postoperative clinical function, fusion status, reoperation rate, complication rate, and hospital stay (p>0.05). Pooled estimates revealed that the unilateral group was associated with significantly reduced implant cost, operative time and blood loss (p<0.05). Our meta-analysis suggested TLIF with unilateral PS fixation was as safe and effective as that with bilateral PS fixation for lumbar diseases in selected patients. Despite these findings, our meta-analysis was based on studies with small sample size and different study characteristics that might lead to the inconsistent results such as various functional outcomes among the included studies. Therefore, high-quality randomized controlled trials with larger sample size are also needed to further clarify these issues and to provide the long-term outcomes.PLoS ONE 01/2014; 9(1):e87501. DOI:10.1371/journal.pone.0087501 · 3.53 Impact Factor
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ABSTRACT: The application of percutaneous techniques for the management of thoracolumbar fractures is gaining popularity. Short-segment or long-segment percutaneous pedicle screw fixation can be used to treat a wide variety of thoracolumbar fractures in patients who are neurologically normal. This approach provides internal fixation, allowing the fracture to heal and sparing the motion segments above and below the fracture, as the instrumentation can be removed later.Neurosurgery clinics of North America 04/2014; 25(2):337-346. DOI:10.1016/j.nec.2013.12.011 · 1.54 Impact Factor