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Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results
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NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.505
P180. Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results David C. Briski, MD1, Brandon W. Cook, MD2, Joseph M. Zavatsky, MD3; 1 Ochsner Medical Center, Jefferson, LA, USA; 2Ochsner Foundation Clinic, Jefferson, LA, USA; 3Spine & Scoliosis Specialists, Tampa, FL, USA BACKGROUND CONTEXT: The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft tissue disruption, blood loss, and shorter length of stay (LOS). The various MIS techniques each have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. PURPOSE: To evaluate if lateral lumbar interbody fusion (LLIF) will have lower VAS scores, EBL, and shorter LOS compared to transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING: Multi-center retrospective review. PATIENT SAMPLE: One hundred seventy-three patients with 2-year followup. LLIF—74 patients, TLIF—99 patients. OUTCOME MEASURES: Operative time and blood loss, postoperative VAS scores, and length of stay. METHODS: All patients with 1- and 2-level MIS LLIF and TLIF procedures with 2-year follow-up were included. Total operative time, blood loss, immediate postop and day of discharge VAS pain scores, along with LOS were recorded. Patients were divided into 2 groups. Group 1—LLIF; Group 2—TLIF. RESULTS: One hundred seventy-three patients met inclusion criteria. Group 1—74 patients, Group 2—99 patients. There was no difference in BMI, levels fused, perioperative complications, immediate postop or discharge VAS scores between the 2 groups. A significant benefit was observed in the LLIF compared to the TLIF Group regarding the number of patients discharged on Postop Day (POD) 1, (48% vs. 0%, p<.001), overall length of stay (2.1 vs. 3.5 days, p<.001), mean operative time (154 vs. 265 min, p<.001), and total operative blood loss (102 vs. 206 cc, p<.001), respectively. Subgroup analysis of only 1-level procedures (LLIF: 59 patients; TLIF: 80 patients) only strengthened the statistical analysis. CONCLUSIONS: There was no difference in perioperative complications, immediate postop or discharge VAS scores between the 2 Groups. The overall LOS was significantly lower in the LLIF Group and the number of patients discharged on POD 1 was significantly higher. Total operative time and blood loss was also significantly lower in the LLIF Group. Further prospective analysis is required to better delineate the financial implications and the comprehensive benefits of one procedure over the other. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.506
P181. Fluoroscopy and Surgery Times in Freehand Open, Freehand Minimally Invasive and Robotic Minimally Invasive, Short and Long Fusions Thomas M. Sweeney II, MD, PhD1, Tan D. Ly, DO2; 1Southeastern Spine Center & Research Institute, Sarasota, FL, USA; 2Southeastern Spine Center, Sarasota, FL, USA BACKGROUND CONTEXT: The current literature on minimally invasive (MIS) thoraco-lumbar fusions favors this technique over the standard
open approach for surgical and medical outcomes. However, while MIS is becoming more common, it is still routinely performed by a minority of surgeons and is typically limited to short fusions, where its clinical impact is smaller. MIS of 4 or more levels is rare due to the challenges in surgical technique (eg, rod insertion) which lengthen overall procedure time and dramatically increase the use of fluoroscopy. PURPOSE: To assess the impact of robotic-guidance on surgery time and intraoperative exposure to radiation in both short and long fusions. STUDY DESIGN/SETTING: Single community hospital, 2 surgeons, retrospective cohorts, comparative analysis. PATIENT SAMPLE: Adults with thoracolumbar degenerative conditions requiring fusion surgery. OUTCOME MEASURES: Total procedure time (“skin-to-skin”) per screw (minutes) and total fluoroscopy per screw (seconds). METHODS: A review of medical records of consecutive patients operated with robotic guidance (Renaissance, Mazor Robotics Ltd., Caesarea, Israel), and matched controls operated by the same surgeons, prior to adoption of robotic-guidance. Patients were operated either in a robotic-guided MIS approach (RG MIS), image-guided minimally invasive (FH MIS) or an open freehand approach (FH Open). RESULTS: Of 268 patients, 167 were in the RG MIS group, 46 in FH MIS and 53 in the FH Open. WIth a mean age of 68, RG MIS was significantly older than FH MIS (mean 61, p=.001). The mean age of FH Open was 65 (p=.093). There was no difference in sex and BMI between the 3 groups. RG MIS averaged 8.2 screws per case, while in FH MIS it was 5.6 (p<.001) and 8.7 in FH Open (p>.05). Total procedure time by number of levels operated was significantly faster in RG MIS compared to both freehand groups. RO MIS 2-level cases had a mean of 134 minutes compared to 170 minutes for FH MIS and 206 minutes for FH Open, which are similar to the 185 minutes average time for RO MIS in the group of 4 or more levels. Mean fluoroscopy time grouped by number of levels operated was significantly and consistently reduced in RG MIS compared to both freehand groups by 55–72%. CONCLUSIONS: Utilization of robotic-guidance in thoraco-lumbar fusions enables performance of multi-level fusions MIS, while significantly reducing the amount of fluoroscopy and overall surgery time, when normalized per level, compared to freehand MIS and open techniques. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2016.07.507
P182. Efficacy of Liposomal Bupivacaine for Postoperative Pain after Spine Surgery Jonathan Hughes, MD1, Christopher D. Chaput, MD2, Yolanda Munoz Maldonado, PhD1, Mark D. Rahm, MD3; 1Baylor Scott and White, Temple, TX, USA; 2Scott & White Hospital, Temple, TX, USA; 3 Baylor Scott and White Health, Temple, TX, USA BACKGROUND CONTEXT: Pain control following spine surgery can be challenging. Uncontrolled pain postoperatively can delay discharge, influence patient recovery, outcomes, and return to normal activities. Recently, there has been increasing interest in the use of multimodal pain regimens, including local perioperative analgesia, over postoperative narcotic and opioid use. Although the use of liposomal bupivacaine (LB) in general surgery and total joint arthroplasty has been studied, a PubMed search revealed no prior clinical data in the setting of spine surgery. PURPOSE: Assess the utility of using LB in spine surgery to decrease length of stay and improve perioperative pain control. STUDY DESIGN/SETTING: This study is a retrospective matched casecontrol study (Level III evidence). PATIENT SAMPLE: Forty-eight patients who underwent elective spine surgery utilizing an incision less than 8 cm at a single center. OUTCOME MEASURES: Length of hospital stay and cost analysis, postoperative morphine equivalent use, VAS, presence of medication related side effects, and the rate of wound complications.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
NASS 31st Annual Meeting Proceedings / The Spine Journal 16 (2016) S251–S337
FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.505
P180. Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF) versus Transforaminal Lumbar Interbody Fusion (TLIF): Patient Centered Results David C. Briski, MD1, Brandon W. Cook, MD2, Joseph M. Zavatsky, MD3; 1 Ochsner Medical Center, Jefferson, LA, USA; 2Ochsner Foundation Clinic, Jefferson, LA, USA; 3Spine & Scoliosis Specialists, Tampa, FL, USA BACKGROUND CONTEXT: The documented benefits of minimally invasive surgery (MIS) continue to be elucidated. These include decreased soft tissue disruption, blood loss, and shorter length of stay (LOS). The various MIS techniques each have inherent benefits. The direct patient benefit of the one procedure over the other (LLIF vs. TLIF) has yet to be clinically established. We analyzed the operative time and blood loss, postoperative VAS scores, and LOS associated with each procedure. PURPOSE: To evaluate if lateral lumbar interbody fusion (LLIF) will have lower VAS scores, EBL, and shorter LOS compared to transforaminal lumbar interbody fusion (TLIF). STUDY DESIGN/SETTING: Multi-center retrospective review. PATIENT SAMPLE: One hundred seventy-three patients with 2-year followup. LLIF—74 patients, TLIF—99 patients. OUTCOME MEASURES: Operative time and blood loss, postoperative VAS scores, and length of stay. METHODS: All patients with 1- and 2-level MIS LLIF and TLIF procedures with 2-year follow-up were included. Total operative time, blood loss, immediate postop and day of discharge VAS pain scores, along with LOS were recorded. Patients were divided into 2 groups. Group 1—LLIF; Group 2—TLIF. RESULTS: One hundred seventy-three patients met inclusion criteria. Group 1—74 patients, Group 2—99 patients. There was no difference in BMI, levels fused, perioperative complications, immediate postop or discharge VAS scores between the 2 groups. A significant benefit was observed in the LLIF compared to the TLIF Group regarding the number of patients discharged on Postop Day (POD) 1, (48% vs. 0%, p<.001), overall length of stay (2.1 vs. 3.5 days, p<.001), mean operative time (154 vs. 265 min, p<.001), and total operative blood loss (102 vs. 206 cc, p<.001), respectively. Subgroup analysis of only 1-level procedures (LLIF: 59 patients; TLIF: 80 patients) only strengthened the statistical analysis. CONCLUSIONS: There was no difference in perioperative complications, immediate postop or discharge VAS scores between the 2 Groups. The overall LOS was significantly lower in the LLIF Group and the number of patients discharged on POD 1 was significantly higher. Total operative time and blood loss was also significantly lower in the LLIF Group. Further prospective analysis is required to better delineate the financial implications and the comprehensive benefits of one procedure over the other. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2016.07.506
P181. Fluoroscopy and Surgery Times in Freehand Open, Freehand Minimally Invasive and Robotic Minimally Invasive, Short and Long Fusions Thomas M. Sweeney II, MD, PhD1, Tan D. Ly, DO2; 1Southeastern Spine Center & Research Institute, Sarasota, FL, USA; 2Southeastern Spine Center, Sarasota, FL, USA BACKGROUND CONTEXT: The current literature on minimally invasive (MIS) thoraco-lumbar fusions favors this technique over the standard
open approach for surgical and medical outcomes. However, while MIS is becoming more common, it is still routinely performed by a minority of surgeons and is typically limited to short fusions, where its clinical impact is smaller. MIS of 4 or more levels is rare due to the challenges in surgical technique (eg, rod insertion) which lengthen overall procedure time and dramatically increase the use of fluoroscopy. PURPOSE: To assess the impact of robotic-guidance on surgery time and intraoperative exposure to radiation in both short and long fusions. STUDY DESIGN/SETTING: Single community hospital, 2 surgeons, retrospective cohorts, comparative analysis. PATIENT SAMPLE: Adults with thoracolumbar degenerative conditions requiring fusion surgery. OUTCOME MEASURES: Total procedure time (“skin-to-skin”) per screw (minutes) and total fluoroscopy per screw (seconds). METHODS: A review of medical records of consecutive patients operated with robotic guidance (Renaissance, Mazor Robotics Ltd., Caesarea, Israel), and matched controls operated by the same surgeons, prior to adoption of robotic-guidance. Patients were operated either in a robotic-guided MIS approach (RG MIS), image-guided minimally invasive (FH MIS) or an open freehand approach (FH Open). RESULTS: Of 268 patients, 167 were in the RG MIS group, 46 in FH MIS and 53 in the FH Open. WIth a mean age of 68, RG MIS was significantly older than FH MIS (mean 61, p=.001). The mean age of FH Open was 65 (p=.093). There was no difference in sex and BMI between the 3 groups. RG MIS averaged 8.2 screws per case, while in FH MIS it was 5.6 (p<.001) and 8.7 in FH Open (p>.05). Total procedure time by number of levels operated was significantly faster in RG MIS compared to both freehand groups. RO MIS 2-level cases had a mean of 134 minutes compared to 170 minutes for FH MIS and 206 minutes for FH Open, which are similar to the 185 minutes average time for RO MIS in the group of 4 or more levels. Mean fluoroscopy time grouped by number of levels operated was significantly and consistently reduced in RG MIS compared to both freehand groups by 55–72%. CONCLUSIONS: Utilization of robotic-guidance in thoraco-lumbar fusions enables performance of multi-level fusions MIS, while significantly reducing the amount of fluoroscopy and overall surgery time, when normalized per level, compared to freehand MIS and open techniques. FDA DEVICE/DRUG STATUS: Mazor Robotics Renaissance (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2016.07.507
P182. Efficacy of Liposomal Bupivacaine for Postoperative Pain after Spine Surgery Jonathan Hughes, MD1, Christopher D. Chaput, MD2, Yolanda Munoz Maldonado, PhD1, Mark D. Rahm, MD3; 1Baylor Scott and White, Temple, TX, USA; 2Scott & White Hospital, Temple, TX, USA; 3 Baylor Scott and White Health, Temple, TX, USA BACKGROUND CONTEXT: Pain control following spine surgery can be challenging. Uncontrolled pain postoperatively can delay discharge, influence patient recovery, outcomes, and return to normal activities. Recently, there has been increasing interest in the use of multimodal pain regimens, including local perioperative analgesia, over postoperative narcotic and opioid use. Although the use of liposomal bupivacaine (LB) in general surgery and total joint arthroplasty has been studied, a PubMed search revealed no prior clinical data in the setting of spine surgery. PURPOSE: Assess the utility of using LB in spine surgery to decrease length of stay and improve perioperative pain control. STUDY DESIGN/SETTING: This study is a retrospective matched casecontrol study (Level III evidence). PATIENT SAMPLE: Forty-eight patients who underwent elective spine surgery utilizing an incision less than 8 cm at a single center. OUTCOME MEASURES: Length of hospital stay and cost analysis, postoperative morphine equivalent use, VAS, presence of medication related side effects, and the rate of wound complications.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.