PMID- 34905727 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 36 IP - 5 DP - 2022 May 1 TI - Minimally invasive versus open lumbar spinal fusion: a matched study investigating patient-reported and surgical outcomes. PG - 753-766 LID - 10.3171/2021.10.SPINE211128 [doi] AB - OBJECTIVE: With the expanding indications for and increasing popularity of minimally invasive surgery (MIS) for lumbar spinal fusion, large-scale outcomes analysis to compare MIS approaches with open procedures is warranted. METHODS: The authors queried the Quality Outcomes Database for patients who underwent elective lumbar fusion for degenerative spine disease. They performed optimal matching, at a 1:2 ratio between patients who underwent MIS and those who underwent open lumbar fusion, to create two highly homogeneous groups in terms of 33 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, indications, and operative details). The outcomes of interest were overall satisfaction, decrease in Oswestry Disability Index (ODI), and back and leg pain, as well as hospital length of stay (LOS), operative time, reoperations, and incidental durotomy rate. Satisfaction was defined as a score of 1 or 2 on the North American Spine Society scale. Minimal clinically important difference (MCID) in ODI was defined as >/= 30% decrease from baseline. Outcomes were assessed at the 3- and 12-month follow-up evaluations. RESULTS: After the groups were matched, the MIS and open groups consisted of 1483 and 2966 patients, respectively. Patients who underwent MIS fusion had higher odds of satisfaction at 3 months (OR 1.4, p = 0.004); no difference was demonstrated at 12 months (OR 1.04, p = 0.67). Lumbar stenosis, single-level fusion, higher American Society of Anesthesiologists Physical Status Classification System grade, and absence of spondylolisthesis were most prominently associated with higher odds of satisfaction with MIS compared with open surgery. Patients in the MIS group had slightly lower ODI scores at 3 months (mean difference 1.61, p = 0.006; MCID OR 1.14, p = 0.0495) and 12 months (mean difference 2.35, p < 0.001; MCID OR 1.29, p < 0.001). MIS was also associated with a greater decrease in leg and back pain at both follow-up time points. The two groups did not differ in operative time and incidental durotomy rate; however, LOS was shorter for the MIS group. Revision surgery at 12 months was less likely for patients who underwent MIS (4.1% vs 5.6%, p = 0.032). CONCLUSIONS: In patients who underwent lumbar fusion for degenerative spinal disease, MIS was associated with higher odds of satisfaction at 3 months postoperatively. No difference was demonstrated at the 12-month follow-up. MIS maintained a small, yet consistent, superiority in decreasing ODI and back and leg pain, and MIS was associated with a lower reoperation rate. FAU - Mooney, James AU - Mooney J AD - 1Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama. FAU - Michalopoulos, Giorgos D AU - Michalopoulos GD AD - 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Alvi, Mohammed Ali AU - Alvi MA AD - 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. FAU - Zeitouni, Daniel AU - Zeitouni D AD - 4School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. FAU - Chan, Andrew K AU - Chan AK AD - 5Department of Neurological Surgery, University of California, San Francisco, California. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 5Department of Neurological Surgery, University of California, San Francisco, California. FAU - Bisson, Erica F AU - Bisson EF AD - 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. FAU - Sherrod, Brandon A AU - Sherrod BA AD - 6Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah. FAU - Haid, Regis W AU - Haid RW AD - 7Atlanta Brain and Spine Care, Atlanta, Georgia. FAU - Knightly, John J AU - Knightly JJ AD - 8Atlantic Neurosurgical Specialists, Morristown, New Jersey. FAU - Devin, Clinton J AU - Devin CJ AD - 9Steamboat Orthopaedic and Spine Institute, Steamboat Springs, Colorado. FAU - Pennicooke, Brenton AU - Pennicooke B AD - 10Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri; and. FAU - Asher, Anthony L AU - Asher AL AD - 11Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas Healthcare System, Charlotte, North Carolina. FAU - Bydon, Mohamad AU - Bydon M AD - 2Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. AD - 3Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. LA - eng PT - Journal Article DEP - 20211214 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - QOD OT - Quality Outcomes Database OT - degenerative OT - lumbar spinal fusion OT - minimally invasive surgery OT - optimal matching OT - patient-reported outcomes OT - tubular retractor EDAT- 2021/12/15 06:00 MHDA- 2021/12/15 06:01 CRDT- 2021/12/14 20:04 PHST- 2021/08/26 00:00 [received] PHST- 2021/10/06 00:00 [accepted] PHST- 2021/12/15 06:01 [medline] PHST- 2021/12/15 06:00 [pubmed] PHST- 2021/12/14 20:04 [entrez] AID - 10.3171/2021.10.SPINE211128 [doi] PST - epublish SO - J Neurosurg Spine. 2021 Dec 14;36(5):753-766. doi: 10.3171/2021.10.SPINE211128. Print 2022 May 1.