Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis

Analysis of the Quality Outcomes Database

Praveen V. Mummaneni, Erica F. Bisson, Panagiotis Kerezoudis, Steven Glassman, Kevin Foley, Jonathan R. Slotkin, Eric Potts, Mark Shaffrey, Christopher I. Shaffrey, Domagoj Coric, John Knightly, Paul Park, Kai Ming Fu, Clinton J. Devin, Silky Chotai, Andrew K. Chan, Michael Virk, Anthony L. Asher, Mohamad Bydon

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p < 0.001). MIS was associated with a significantly lower mean intraoperative estimated blood loss and slightly longer operative times in both 1- and 2-level fusion subgroups. Although the LOS was shorter for MIS 1-level cases, this was not significantly different. No difference was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (-27 vs -16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (-3.5 vs -2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (-4.9 vs -2.8, p = 0.02). On riskadjusted analysis for 1-level fusion, open versus minimally invasive approach was not significant for 12-month PROs, LOS, and 90-day return to work. CONCLUSIONS Significant improvement was found in terms of all functional outcomes in patients undergoing open or MIS fusion for lumbar spondylolisthesis. No difference was detected between the 2 techniques for 1-level fusion in terms of patient-reported outcomes, LOS, and 90-day return to work. However, patients undergoing 2-level MIS fusion reported significantly better improvement in NRS-LP at 12 months than patients undergoing 2-level open surgery. Longer followup is needed to provide further insight into the comparative effectiveness of the 2 procedures.

Original languageEnglish (US)
Article numberE11
JournalNeurosurgical Focus
Volume43
Issue number2
DOIs
StatePublished - Aug 1 2017

Fingerprint

Spondylolisthesis
Minimally Invasive Surgical Procedures
Databases
Length of Stay
Return to Work
Back Pain
Operative Time
Postoperative Pain
Decompression
Registries
Comorbidity
Leg
Demography
Patient Reported Outcome Measures

Keywords

  • Lumbar
  • Minimally invasive surgery
  • Open surgery
  • Quality Outcomes Database
  • Spondylolisthesis

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Mummaneni, P. V., Bisson, E. F., Kerezoudis, P., Glassman, S., Foley, K., Slotkin, J. R., ... Bydon, M. (2017). Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: Analysis of the Quality Outcomes Database. Neurosurgical Focus, 43(2), [E11]. https://doi.org/10.3171/2017.5.FOCUS17188

Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis : Analysis of the Quality Outcomes Database. / Mummaneni, Praveen V.; Bisson, Erica F.; Kerezoudis, Panagiotis; Glassman, Steven; Foley, Kevin; Slotkin, Jonathan R.; Potts, Eric; Shaffrey, Mark; Shaffrey, Christopher I.; Coric, Domagoj; Knightly, John; Park, Paul; Fu, Kai Ming; Devin, Clinton J.; Chotai, Silky; Chan, Andrew K.; Virk, Michael; Asher, Anthony L.; Bydon, Mohamad.

In: Neurosurgical Focus, Vol. 43, No. 2, E11, 01.08.2017.

Research output: Contribution to journalArticle

Mummaneni, PV, Bisson, EF, Kerezoudis, P, Glassman, S, Foley, K, Slotkin, JR, Potts, E, Shaffrey, M, Shaffrey, CI, Coric, D, Knightly, J, Park, P, Fu, KM, Devin, CJ, Chotai, S, Chan, AK, Virk, M, Asher, AL & Bydon, M 2017, 'Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: Analysis of the Quality Outcomes Database', Neurosurgical Focus, vol. 43, no. 2, E11. https://doi.org/10.3171/2017.5.FOCUS17188
Mummaneni, Praveen V. ; Bisson, Erica F. ; Kerezoudis, Panagiotis ; Glassman, Steven ; Foley, Kevin ; Slotkin, Jonathan R. ; Potts, Eric ; Shaffrey, Mark ; Shaffrey, Christopher I. ; Coric, Domagoj ; Knightly, John ; Park, Paul ; Fu, Kai Ming ; Devin, Clinton J. ; Chotai, Silky ; Chan, Andrew K. ; Virk, Michael ; Asher, Anthony L. ; Bydon, Mohamad. / Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis : Analysis of the Quality Outcomes Database. In: Neurosurgical Focus. 2017 ; Vol. 43, No. 2.
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abstract = "OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84{\%} (83.5{\%} [open surgery]; 85{\%} [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p < 0.001). MIS was associated with a significantly lower mean intraoperative estimated blood loss and slightly longer operative times in both 1- and 2-level fusion subgroups. Although the LOS was shorter for MIS 1-level cases, this was not significantly different. No difference was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (-27 vs -16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (-3.5 vs -2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (-4.9 vs -2.8, p = 0.02). On riskadjusted analysis for 1-level fusion, open versus minimally invasive approach was not significant for 12-month PROs, LOS, and 90-day return to work. CONCLUSIONS Significant improvement was found in terms of all functional outcomes in patients undergoing open or MIS fusion for lumbar spondylolisthesis. No difference was detected between the 2 techniques for 1-level fusion in terms of patient-reported outcomes, LOS, and 90-day return to work. However, patients undergoing 2-level MIS fusion reported significantly better improvement in NRS-LP at 12 months than patients undergoing 2-level open surgery. Longer followup is needed to provide further insight into the comparative effectiveness of the 2 procedures.",
keywords = "Lumbar, Minimally invasive surgery, Open surgery, Quality Outcomes Database, Spondylolisthesis",
author = "Mummaneni, {Praveen V.} and Bisson, {Erica F.} and Panagiotis Kerezoudis and Steven Glassman and Kevin Foley and Slotkin, {Jonathan R.} and Eric Potts and Mark Shaffrey and Shaffrey, {Christopher I.} and Domagoj Coric and John Knightly and Paul Park and Fu, {Kai Ming} and Devin, {Clinton J.} and Silky Chotai and Chan, {Andrew K.} and Michael Virk and Asher, {Anthony L.} and Mohamad Bydon",
year = "2017",
month = "8",
day = "1",
doi = "10.3171/2017.5.FOCUS17188",
language = "English (US)",
volume = "43",
journal = "Neurosurgical Focus",
issn = "1092-0684",
publisher = "American Association of Neurological Surgeons",
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TY - JOUR

T1 - Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis

T2 - Analysis of the Quality Outcomes Database

AU - Mummaneni, Praveen V.

AU - Bisson, Erica F.

AU - Kerezoudis, Panagiotis

AU - Glassman, Steven

AU - Foley, Kevin

AU - Slotkin, Jonathan R.

AU - Potts, Eric

AU - Shaffrey, Mark

AU - Shaffrey, Christopher I.

AU - Coric, Domagoj

AU - Knightly, John

AU - Park, Paul

AU - Fu, Kai Ming

AU - Devin, Clinton J.

AU - Chotai, Silky

AU - Chan, Andrew K.

AU - Virk, Michael

AU - Asher, Anthony L.

AU - Bydon, Mohamad

PY - 2017/8/1

Y1 - 2017/8/1

N2 - OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p < 0.001). MIS was associated with a significantly lower mean intraoperative estimated blood loss and slightly longer operative times in both 1- and 2-level fusion subgroups. Although the LOS was shorter for MIS 1-level cases, this was not significantly different. No difference was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (-27 vs -16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (-3.5 vs -2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (-4.9 vs -2.8, p = 0.02). On riskadjusted analysis for 1-level fusion, open versus minimally invasive approach was not significant for 12-month PROs, LOS, and 90-day return to work. CONCLUSIONS Significant improvement was found in terms of all functional outcomes in patients undergoing open or MIS fusion for lumbar spondylolisthesis. No difference was detected between the 2 techniques for 1-level fusion in terms of patient-reported outcomes, LOS, and 90-day return to work. However, patients undergoing 2-level MIS fusion reported significantly better improvement in NRS-LP at 12 months than patients undergoing 2-level open surgery. Longer followup is needed to provide further insight into the comparative effectiveness of the 2 procedures.

AB - OBJECTIVE Lumbar spondylolisthesis is a degenerative condition that can be surgically treated with either open or minimally invasive decompression and instrumented fusion. Minimally invasive surgery (MIS) approaches may shorten recovery, reduce blood loss, and minimize soft-tissue damage with resultant reduced postoperative pain and disability. METHODS The authors queried the national, multicenter Quality Outcomes Database (QOD) registry for patients undergoing posterior lumbar fusion between July 2014 and December 2015 for Grade I degenerative spondylolisthesis. The authors recorded baseline and 12-month patient-reported outcomes (PROs), including Oswestry Disability Index (ODI), EQ-5D, numeric rating scale (NRS)-back pain (NRS-BP), NRS-leg pain (NRS-LP), and satisfaction (North American Spine Society satisfaction questionnaire). Multivariable regression models were fitted for hospital length of stay (LOS), 12-month PROs, and 90-day return to work, after adjusting for an array of preoperative and surgical variables. RESULTS A total of 345 patients (open surgery, n = 254; MIS, n = 91) from 11 participating sites were identified in the QOD. The follow-up rate at 12 months was 84% (83.5% [open surgery]; 85% [MIS]). Overall, baseline patient demographics, comorbidities, and clinical characteristics were similarly distributed between the cohorts. Two hundred fifty seven patients underwent 1-level fusion (open surgery, n = 181; MIS, n = 76), and 88 patients underwent 2-level fusion (open surgery, n = 73; MIS, n = 15). Patients in both groups reported significant improvement in all primary outcomes (all p < 0.001). MIS was associated with a significantly lower mean intraoperative estimated blood loss and slightly longer operative times in both 1- and 2-level fusion subgroups. Although the LOS was shorter for MIS 1-level cases, this was not significantly different. No difference was detected with regard to the 12-month PROs between the 1-level MIS versus the 1-level open surgical groups. However, change in functional outcome scores for patients undergoing 2-level fusion was notably larger in the MIS cohort for ODI (-27 vs -16, p = 0.1), EQ-5D (0.27 vs 0.15, p = 0.08), and NRS-BP (-3.5 vs -2.7, p = 0.41); statistical significance was shown only for changes in NRS-LP scores (-4.9 vs -2.8, p = 0.02). On riskadjusted analysis for 1-level fusion, open versus minimally invasive approach was not significant for 12-month PROs, LOS, and 90-day return to work. CONCLUSIONS Significant improvement was found in terms of all functional outcomes in patients undergoing open or MIS fusion for lumbar spondylolisthesis. No difference was detected between the 2 techniques for 1-level fusion in terms of patient-reported outcomes, LOS, and 90-day return to work. However, patients undergoing 2-level MIS fusion reported significantly better improvement in NRS-LP at 12 months than patients undergoing 2-level open surgery. Longer followup is needed to provide further insight into the comparative effectiveness of the 2 procedures.

KW - Lumbar

KW - Minimally invasive surgery

KW - Open surgery

KW - Quality Outcomes Database

KW - Spondylolisthesis

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