Systematic Reviews
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2015; 6(11): 996-1005
Published online Dec 18, 2015. doi: 10.5312/wjo.v6.i11.996
Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review
Branko Skovrlj, Patrick Belton, Hekmat Zarzour, Sheeraz A Qureshi
Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Patrick Belton, State University of New York Upstate Medical University, Syracuse, NY 13210, United States
Sheeraz A Qureshi, Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: Skovrlj B, Belton P, Zarzour H and Qureshi SA contributed equally to data collection, literature review, composition of manuscript, final drafting and editing; all authors approve to the submission.
Conflict-of-interest statement: None of the authors have conflicts of interest in relationship to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sheeraz A Qureshi, MD, MBA, Department of Orthopaedic Surgery, Ichan School of Medicine at Mount Sinai, 5 East 98th Street, 4th Floor, Box 1188, New York, NY 10029, United States. sheeraz.qureshi@mountsinai.org
Telephone: +1-212-2413909 Fax: +1-646-5378535
Received: February 27, 2015
Peer-review started: February 27, 2015
First decision: April 28, 2015
Revised: July 21, 2015
Accepted: August 4, 2015
Article in press: August 7, 2015
Published online: December 18, 2015
Processing time: 293 Days and 7 Hours
Abstract

AIM: To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).

METHODS: A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.

RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.

CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time.

Keywords: Minimally invasive; Spine surgery; Lumbar spine; Perioperative outcomes; Estimated blood loss; Neurologic complications; Transfusion; Postoperative pain; Narcotic use; Length of stay; Length of surgery

Core tip: Perioperative outcomes in minimally invasive (MIS) approaches to the lumbar spine have not been specifically examined in systematic reviews of MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries. Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time.