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Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion (MITLIF): Results of 670 Cases Discharged the Day of Surgery
Proceedings of the NASS 27th Annual Meeting / The Spine Journal 12 (2012) 99S–165S by the Cobb angle between inferior endplate of the cephalad and caudal vertebral body of FSU in AP radiographs. METHODS: To analyze the effect of OCB and FCB on clinical and the other radiographic sagittal kinematics, patients were postoperatively divided into two groups (group IA(OCB#5 ) vs group IIA(OCBO5 ), group IB(FCB#5 ) vs group IIB(FCBO5 )) and compared. RESULTS: There was no significant difference in VAS and NDI between group IA and group IIA before and after surgery. Preoperative FSU ROM was preserved in group IA, instead, preoperative FSU ROM was significantly decreased in group IIA from 12.565.0 to 8.465.4 (p50.041). The OC-A and FSU-A were increased in Group IA from 11.7611.0 to 15.868.0 (p50.002) and from 0.066.4 to 2.266.4 (p50.031). There was no significant difference in VAS and NDI between group IB (FCB#5 ) and group IIB (FCBO5 ). OC-A and FSU-A were increased in Group IB (FCBO5 ) from 11.1 610.4 to 14.7 68.6 (p50.020) and from -0.5 66.1 to 1.4 66.8 (p50.008). In adjacent segment, anterior disc height at superior adjacent level and ROM at inferior adjacent level were significantly decreased in Group IA and IB. The postoperative OCB was highly correlated to the preoperative OCB (p50.000) and also correlated to the postoperative FCB (p50.041). But other variables including preoperative sagittal kinematics (OC-ROM (p50.744), FSU ROM (p50.344), OC-A(p50.921), FSUA(p50.069)), types of artificial disc(p50.843), age(p50.121) and gender(p50.789) were not correlated. Postoperative FCB and preoperative FCB were statistically correlated (p50.001). CONCLUSIONS: Like any other factors which might contribute to radiographic sagittal kinematics in cervical arthroplasty, maintenance of coronal balance(less than 5 ) also need to be considered as one of the important factors to achieve the goal of cervical arthroplasty for a long time. FDA DEVICE/DRUG STATUS: Bryan artifical disc (Approved for this indication), ProDisc-C artificial disc (Approved for this indication), Prestige LP artificial disc (Approved for this indication) http://dx.doi.org/10.1016/j.spinee.2012.08.319 P46. Unilateral Minimally Invasive Transforaminal Lumbar Interbody Fusion (MITLIF): Results of 670 Cases Discharged the Day of Surgery Walter W. Eckman, MD, Lynda G. Hester, PT, Michelle McMillen, RN; Aurora Spine Center, Tupelo, MS, US BACKGROUND CONTEXT: MITLIF patients can return home on the day of surgery. PURPOSE: Data is needed to evaluate results in a diverse large series of patients undergoing single and two level procedures. STUDY DESIGN/SETTING: Evaluation of outcomes following same day discharge for patients undergoing unilateral MITLIF. PATIENT SAMPLE: Prospective study of 670 procedures from 3/18/03 to 12/30/11 in 606 patients (319 male, 287 females) ages 17 to 83 (average 51). Diagnoses included chronic back pain, stenosis, listhesis, segmental instability and central disk herniation. A large majority needed relief from involvement of neuroforamina or the spinal canal. OUTCOME MEASURES: Outcomes were evaluated for: incidence of transfusion, infection or reoperation at index level; Waddell’s Severity Score; VAS for back, upper leg and lower leg pain. Return to work was evaluated for those who were working within 30 days prior to surgery (394), with data available on 384 patients. Fusion: Patients returned for reformatted thin slice CT scans at 1 year or longer after 308 procedures to evaluate interbody fusion. METHODS: Surgery: One or 2 level MITLIF through a single incision using a 21 mm diameter working channel with titanium or polymeric interbody devices, BMP2 or Silicated Calcium Phosphate bone graft substitutes and unilateral pedicle screw fixation. RESULTS: Transfusion: 0.3% (2/670) Surgical Infection: 0 Reoperations: 2.3% (16/670) Interbody Fusion: Complete 94% (290/308); Incomplete 4.5% (14/308); Non-union 1.3% (4/308) Return to Work: 96% (367/ 384); two the next day Average Outcomes: Waddell VAS Back VAS UL
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VASLL Pre-op 5.2 6.7 4.9 3.7 3 Months (n5529) 2.5 2.0 0.9 1.0 1 Year (n5252) 1.8 2.4 1.0 0.8 2 Years (n5129) 1.8 2.5 1.3 1.2 Effectiveness: Improved at 2 Years 90% 88% 85% 92% Avg Improvement 73% 75% 82% 69% CONCLUSIONS: 1. Unilateral MITLIF is a successful outpatient procedure with patients routinely discharged the day of surgery. 2. MITLIF with unilateral pedicle fixation has low morbidity and provides excellent results out to two years. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.320 P47. Extent of Preoperative Depression is Associated with Return to Work After Lumbar Fusion for Spondylolisthesis Scott L. Parker, MD1, Scott L. Zuckerman1, David N. Shau, BS1, Stephen K. Mendenhall1, Saniya S. Godil, MD2, Matthew J. McGirt, MD3; 1 Nashville, TN, US; 2Vanderbilt University, Nashville, TN, US; 3Vanderbilt University Medical Center, Nashville, TN, US BACKGROUND CONTEXT: Growing evidence suggests that the variability observed in outcomes after spine surgery may be partially attributed to pre-operative psychological predispositions such as depression. Low back pain is the most expensive cause of work-related disability in the U.S., with indirect costs secondary to missed work contributing a significant portion of overall cost. The ability to understand factors associated with an increased duration of missed work postoperatively could be used to more effectively select patients with the greatest opportunity for a successful outcome, while at the same time reducing the associated indirect costs of spine surgery. PURPOSE: We set out to determine the effect of pre-operative depression on postoperative return to work in patients undergoing TLIF for degenerative spondylolisthesis. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Fifty-eight patients undergoing TLIF for symptomatic back and leg pain secondary to grade I degenerative lumbar spondylolisthesis. OUTCOME MEASURES: VAs, ODI, EQ-5D METHODS: Fifty-eight patients undergoing TLIF for symptomatic back and leg pain secondary to grade I degenerative lumbar spondylolisthesis were included in this analysis. Patient demographics, clinical presentation, indications for surgery, radiological studies, and operative variables were assessed for each case. Patient-assessed outcome measures (VAS, ODI, EQ-5D) were prospectively obtained via phone interview at baseline and two-years postoperatively. To understand the factors associated with prolonged return to work, univariate linear regression analysis and stepwise multivariate Cox proportional hazards model was used. RESULTS: All patient-reported outcomes assessed (VAS, ODI, EQ-5D) were significantly improved two years after TLIF (p!0.001). Of the 32 patients working prior to surgery, 26 (81%) returned to work postoperatively. The median time to return to work (RTW) was 56 days (range: 10-150 days). Independent of patient age; pre-operative pain, disability, and quality of life; as well as extent of postoperative improvement, increased preoperative Zung depression score remained significantly associated with a prolonged return to work (p50.02). For patients with a pre-operative Zung score of 20-35, 36-50, and 51-65 median time to return to work was 42 days, 75 days, and 150 days, respectively. CONCLUSIONS: Independent of postoperative improvement in pain, disability, and quality of life, the extent of pre-operative depression was an independent predictor of time to return to work in patients undergoing TLIF for spondylolisthesis, suggesting that regardless of how successful TLIF surgery may be at improving a patient’s pain, disability, or QOL, greater depression will delay or prohibit their ability to return to work postoperatively. Pre-operative Zung scores may help to identify and stratify patients least likely to return to work postoperatively.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
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VASLL Pre-op 5.2 6.7 4.9 3.7 3 Months (n5529) 2.5 2.0 0.9 1.0 1 Year (n5252) 1.8 2.4 1.0 0.8 2 Years (n5129) 1.8 2.5 1.3 1.2 Effectiveness: Improved at 2 Years 90% 88% 85% 92% Avg Improvement 73% 75% 82% 69% CONCLUSIONS: 1. Unilateral MITLIF is a successful outpatient procedure with patients routinely discharged the day of surgery. 2. MITLIF with unilateral pedicle fixation has low morbidity and provides excellent results out to two years. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2012.08.320 P47. Extent of Preoperative Depression is Associated with Return to Work After Lumbar Fusion for Spondylolisthesis Scott L. Parker, MD1, Scott L. Zuckerman1, David N. Shau, BS1, Stephen K. Mendenhall1, Saniya S. Godil, MD2, Matthew J. McGirt, MD3; 1 Nashville, TN, US; 2Vanderbilt University, Nashville, TN, US; 3Vanderbilt University Medical Center, Nashville, TN, US BACKGROUND CONTEXT: Growing evidence suggests that the variability observed in outcomes after spine surgery may be partially attributed to pre-operative psychological predispositions such as depression. Low back pain is the most expensive cause of work-related disability in the U.S., with indirect costs secondary to missed work contributing a significant portion of overall cost. The ability to understand factors associated with an increased duration of missed work postoperatively could be used to more effectively select patients with the greatest opportunity for a successful outcome, while at the same time reducing the associated indirect costs of spine surgery. PURPOSE: We set out to determine the effect of pre-operative depression on postoperative return to work in patients undergoing TLIF for degenerative spondylolisthesis. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: Fifty-eight patients undergoing TLIF for symptomatic back and leg pain secondary to grade I degenerative lumbar spondylolisthesis. OUTCOME MEASURES: VAs, ODI, EQ-5D METHODS: Fifty-eight patients undergoing TLIF for symptomatic back and leg pain secondary to grade I degenerative lumbar spondylolisthesis were included in this analysis. Patient demographics, clinical presentation, indications for surgery, radiological studies, and operative variables were assessed for each case. Patient-assessed outcome measures (VAS, ODI, EQ-5D) were prospectively obtained via phone interview at baseline and two-years postoperatively. To understand the factors associated with prolonged return to work, univariate linear regression analysis and stepwise multivariate Cox proportional hazards model was used. RESULTS: All patient-reported outcomes assessed (VAS, ODI, EQ-5D) were significantly improved two years after TLIF (p!0.001). Of the 32 patients working prior to surgery, 26 (81%) returned to work postoperatively. The median time to return to work (RTW) was 56 days (range: 10-150 days). Independent of patient age; pre-operative pain, disability, and quality of life; as well as extent of postoperative improvement, increased preoperative Zung depression score remained significantly associated with a prolonged return to work (p50.02). For patients with a pre-operative Zung score of 20-35, 36-50, and 51-65 median time to return to work was 42 days, 75 days, and 150 days, respectively. CONCLUSIONS: Independent of postoperative improvement in pain, disability, and quality of life, the extent of pre-operative depression was an independent predictor of time to return to work in patients undergoing TLIF for spondylolisthesis, suggesting that regardless of how successful TLIF surgery may be at improving a patient’s pain, disability, or QOL, greater depression will delay or prohibit their ability to return to work postoperatively. Pre-operative Zung scores may help to identify and stratify patients least likely to return to work postoperatively.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.