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A Minimally Disruptive Muscle Sparring Approach to Minimally Invasive Spine Surgery in Degenerative Disc Disease: Its Effect on Patient Outcomes: A Comparison to the Classic Open Approach
Proceedings of the NASS 29th Annual Meeting / The Spine Journal 14 (2014) 1S–183S chiropractic care were more satisfied. Patients receiving chiropractic care used more office visits and X-ray studies, but used less advanced imaging, opioids, hospitalization and surgery, and had generally lower health care costs. Although willingness to pay thresholds are not clear for specific health outcomes related to spine pain, HEEs suggest that chiropractic care is likely cost effective. CONCLUSIONS: Several economic evaluations of chiropractic care for spine pain have been conducted in the US in recent decades. Although their findings suggest that chiropractic care may have modest advantages in health care utilization and total costs of health care when compared to care from a medical physician, many shortcomings were uncovered in this literature, including lack of comparability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.263
P10. Are Dural Tears in Minimal Invasive Spine Surgery of the Lumbar Spine More Forgiving than in Open Spine Surgery? Arvind G. Kulkarni, MD; Bombay Hospital, Mumbai, Maharastra, India BACKGROUND CONTEXT: There is a paucity of literature comparing the management and outcomes of cerebrospinal fluid (CSF) leaks in OSS (open spine surgery) and MISS (minimally invasive spine surgery). PURPOSE: To compare the outcomes of CSF leaks in OSS and MISS. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: All OSS and MISS cases during the study period from April 2007-May 2012 undergoing lumbar spine surgery. OUTCOME MEASURES: The parameters, 1) delay in mobilization and 2) excess duration of hospital stay and 3) morbidity, were analyzed using IBMÒ SPSSÒ Statistics version 20. METHODS: All OSS and MISS cases during the study period from April 2007-May 2012 with an accidental dural-tear were retrospectively analyzed. MISS surgeries included procedures done using tubular retractors. The parameters, 1) delay in mobilization and 2) excess duration of hospital stay were analyzed using IBMÒ SPSSÒ Statistics version 20. RESULTS: The total number of spine surgeries performed in the study period was 1023. Dural tears occurred in 23/669 cases of OSS (3.43%) and in 22/354 (6.21%) cases of MISS. In OSS, 20 tears were recognized intraoperatively and repaired, followed by bed rest for 48-72 hours and then mobilized. Two cases with persistent CSF leak required re-exploration and repair. In 3 cases with postoperative CSF collection, insertion of a lumbar drain helped in resolution of symptoms with 2 cases needing re-admission for 5 days. In MISS-group, there were 20 minor-tears and 2 extensive tears. In the first 7 minor tears, fibrin-glue was sprayed over the tear and the last 13 tears were left alone. One patient with a large tear was treated with approximation of the edges and the other needed an open repair. All patients were mobilized after 24 hours, except for the patient with the open repair (48 hours). The mean delay in mobilization was 78.26 hours (OSS) and 26.18 hours (MISS), and the excess stay was 2.35 days (OSS) and 1.5 days compared to cases without DTs in each group. The difference in the two groups was statistically significant (p ! 0.005). CONCLUSIONS: A large dead space encourages collection of CSF requiring adequate repair and/or insertion of a lumbar drain in OSS. While extensive tears may need conversion to open repair in MISS, a large majority of these tears are small and can be left alone without any consequences. The absence of a ‘‘dead space’’ after withdrawing the tubular retractor discourages CSF collection. The management of an incidental durotomy may increase the overall hospital costs in OSS cases as compared to cases dealt with MISS. MISS, being a soft-tissue and bone-sparing surgery, prevents spread of CSF leak outside the spinal-canal. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.264
105S
P11. A Minimally Disruptive Muscle Sparring Approach to Minimally Invasive Spine Surgery in Degenerative Disc Disease: Its Effect on Patient Outcomes: A Comparison to the Classic Open Approach Donald Kucharzyk, DO1, Dushan Budimir, BS2; 1Orthopaedic, Pediatric and Spine Institute, Crown Point, IN, US; 2Downers Grove, IL, US BACKGROUND CONTEXT: Minimally Invasive spine surgery for instrumented lumbar fusions surgery is an attractive concept with advantages for the surgeon patient and the economy. Questions arise as to the effect it really has on patient outcomes and how this compares to the open approach. For it to be accepted it should have similar if not better outcomes to the classic open approach in terms of fusion rates recovery times and to exceed the open approach in terms of shorter hospitalization less blood loss less muscle damage more rapid recovery quicker return to work and improvement in outcome measurements. PURPOSE: A study was undertaken to compare the effects of a muscle sparring minimally disruptive approach to the treatment of degenerative disc disease in the lumbar spine. STUDY DESIGN/SETTING: A retrospective nonrandomized study comparing a series of patients with the diagnosis of degenerative disc disease with instability was performed with over two-year follow-up and divided into the classic open approach and minimally disruptive MIS group utilizing the same instrumentation interbody implants and bone grafting material. PATIENT SAMPLE: 200 patients were identified with this diagnosis and divided 100 into each group. OUTCOME MEASURES: ODI, SF36, BPS, VAS, Return to Work Status. METHODS: All were evaluated for OR time blood loss narcotic use length of hospitalization fusion rates return to work status and outcomes measurements via the ODI, SF36, BPS, and VAS scores. RESULTS: Open: OR time 110min. Blood loss 300ml. Hosp 3.3 days. Narcotic use 51 hrs. Fusion rate 93%. MIS: OR time 90 min. Blood loss 75ml. Hosp 1.5 days. Narcotic use 25hrs. Fusion rate 95%. Complications: Open 4 (2 graft migration, 2 infections). MIS: 1 (graft migration). Return to Work Open/MIS one month 15/30%, three months 30/60%, six months 72/94%, one year 82/97%, two years 80/97%. ODI: Open/MIS preop 52.5/ 54.1, postop 28.4/12.2 SF36: preop 27.6/27.1, postop 39.7/49.6. BPS: preop 16.4/17.1 postop 8.1/2.0 VAS: preop 8.8/9.3, postop 5.5/1.0. CONCLUSIONS: Minimally disruptive muscle sparring approach to minimally invasive spine surgery offered advantages to the properly selected patients revealing shorter OR time, less blood loss, shorter hospitalization, quicker entry into PT and rehabilitation leading to an earlier return-to-work and continuation of work at two-year follow-up compared to the open approach. Improved outcome measurements were noted in the MIS group attributing this to the muscle-sparring minimally disruptive access to the spine limiting damage to the multifidus. Importantly, MIS resulted in similar fusion rates but more patients returned to work sooner and continued working again attributed to the minimally disruptive muscle sparing nature of the approach FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.265
P12. The Causes and Treatment Strategies for the Postoperative Complications of Occipitocervical Region: A 636-Case Retrospective Analysis Baorong He, MD, Dingjun Hao, MD, Liang Yan, PhD, MD; Xi’an, China BACKGROUND CONTEXT: Disorders in occipitocervical region are difficult to treat. Complications often occur after fusion surgery and may be life-threatening in severe cases. PURPOSE: This study is to investigate the causes and treatment strategies for the postoperative complications of occipitocervical region.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
P10. Are Dural Tears in Minimal Invasive Spine Surgery of the Lumbar Spine More Forgiving than in Open Spine Surgery? Arvind G. Kulkarni, MD; Bombay Hospital, Mumbai, Maharastra, India BACKGROUND CONTEXT: There is a paucity of literature comparing the management and outcomes of cerebrospinal fluid (CSF) leaks in OSS (open spine surgery) and MISS (minimally invasive spine surgery). PURPOSE: To compare the outcomes of CSF leaks in OSS and MISS. STUDY DESIGN/SETTING: Retrospective study. PATIENT SAMPLE: All OSS and MISS cases during the study period from April 2007-May 2012 undergoing lumbar spine surgery. OUTCOME MEASURES: The parameters, 1) delay in mobilization and 2) excess duration of hospital stay and 3) morbidity, were analyzed using IBMÒ SPSSÒ Statistics version 20. METHODS: All OSS and MISS cases during the study period from April 2007-May 2012 with an accidental dural-tear were retrospectively analyzed. MISS surgeries included procedures done using tubular retractors. The parameters, 1) delay in mobilization and 2) excess duration of hospital stay were analyzed using IBMÒ SPSSÒ Statistics version 20. RESULTS: The total number of spine surgeries performed in the study period was 1023. Dural tears occurred in 23/669 cases of OSS (3.43%) and in 22/354 (6.21%) cases of MISS. In OSS, 20 tears were recognized intraoperatively and repaired, followed by bed rest for 48-72 hours and then mobilized. Two cases with persistent CSF leak required re-exploration and repair. In 3 cases with postoperative CSF collection, insertion of a lumbar drain helped in resolution of symptoms with 2 cases needing re-admission for 5 days. In MISS-group, there were 20 minor-tears and 2 extensive tears. In the first 7 minor tears, fibrin-glue was sprayed over the tear and the last 13 tears were left alone. One patient with a large tear was treated with approximation of the edges and the other needed an open repair. All patients were mobilized after 24 hours, except for the patient with the open repair (48 hours). The mean delay in mobilization was 78.26 hours (OSS) and 26.18 hours (MISS), and the excess stay was 2.35 days (OSS) and 1.5 days compared to cases without DTs in each group. The difference in the two groups was statistically significant (p ! 0.005). CONCLUSIONS: A large dead space encourages collection of CSF requiring adequate repair and/or insertion of a lumbar drain in OSS. While extensive tears may need conversion to open repair in MISS, a large majority of these tears are small and can be left alone without any consequences. The absence of a ‘‘dead space’’ after withdrawing the tubular retractor discourages CSF collection. The management of an incidental durotomy may increase the overall hospital costs in OSS cases as compared to cases dealt with MISS. MISS, being a soft-tissue and bone-sparing surgery, prevents spread of CSF leak outside the spinal-canal. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.264
105S
P11. A Minimally Disruptive Muscle Sparring Approach to Minimally Invasive Spine Surgery in Degenerative Disc Disease: Its Effect on Patient Outcomes: A Comparison to the Classic Open Approach Donald Kucharzyk, DO1, Dushan Budimir, BS2; 1Orthopaedic, Pediatric and Spine Institute, Crown Point, IN, US; 2Downers Grove, IL, US BACKGROUND CONTEXT: Minimally Invasive spine surgery for instrumented lumbar fusions surgery is an attractive concept with advantages for the surgeon patient and the economy. Questions arise as to the effect it really has on patient outcomes and how this compares to the open approach. For it to be accepted it should have similar if not better outcomes to the classic open approach in terms of fusion rates recovery times and to exceed the open approach in terms of shorter hospitalization less blood loss less muscle damage more rapid recovery quicker return to work and improvement in outcome measurements. PURPOSE: A study was undertaken to compare the effects of a muscle sparring minimally disruptive approach to the treatment of degenerative disc disease in the lumbar spine. STUDY DESIGN/SETTING: A retrospective nonrandomized study comparing a series of patients with the diagnosis of degenerative disc disease with instability was performed with over two-year follow-up and divided into the classic open approach and minimally disruptive MIS group utilizing the same instrumentation interbody implants and bone grafting material. PATIENT SAMPLE: 200 patients were identified with this diagnosis and divided 100 into each group. OUTCOME MEASURES: ODI, SF36, BPS, VAS, Return to Work Status. METHODS: All were evaluated for OR time blood loss narcotic use length of hospitalization fusion rates return to work status and outcomes measurements via the ODI, SF36, BPS, and VAS scores. RESULTS: Open: OR time 110min. Blood loss 300ml. Hosp 3.3 days. Narcotic use 51 hrs. Fusion rate 93%. MIS: OR time 90 min. Blood loss 75ml. Hosp 1.5 days. Narcotic use 25hrs. Fusion rate 95%. Complications: Open 4 (2 graft migration, 2 infections). MIS: 1 (graft migration). Return to Work Open/MIS one month 15/30%, three months 30/60%, six months 72/94%, one year 82/97%, two years 80/97%. ODI: Open/MIS preop 52.5/ 54.1, postop 28.4/12.2 SF36: preop 27.6/27.1, postop 39.7/49.6. BPS: preop 16.4/17.1 postop 8.1/2.0 VAS: preop 8.8/9.3, postop 5.5/1.0. CONCLUSIONS: Minimally disruptive muscle sparring approach to minimally invasive spine surgery offered advantages to the properly selected patients revealing shorter OR time, less blood loss, shorter hospitalization, quicker entry into PT and rehabilitation leading to an earlier return-to-work and continuation of work at two-year follow-up compared to the open approach. Improved outcome measurements were noted in the MIS group attributing this to the muscle-sparring minimally disruptive access to the spine limiting damage to the multifidus. Importantly, MIS resulted in similar fusion rates but more patients returned to work sooner and continued working again attributed to the minimally disruptive muscle sparing nature of the approach FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2014.08.265
P12. The Causes and Treatment Strategies for the Postoperative Complications of Occipitocervical Region: A 636-Case Retrospective Analysis Baorong He, MD, Dingjun Hao, MD, Liang Yan, PhD, MD; Xi’an, China BACKGROUND CONTEXT: Disorders in occipitocervical region are difficult to treat. Complications often occur after fusion surgery and may be life-threatening in severe cases. PURPOSE: This study is to investigate the causes and treatment strategies for the postoperative complications of occipitocervical region.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.