Minimally Invasive Transforaminal Versus Direct Lateral Lumbar Interbody Fusion: Effect on Return to Work, Narcotic Use, and Quality of life

Document Type

Article

Abstract

BACKGROUND: Direct lateral (DLIF) and transforaminal (TLIF) lumbar interbody fusions have been shown to produce satisfactory clinical outcomes with significant reduction in pain and functional disability. Despite their increasing use in complex spinal deformity surgeries, there is a paucity of data comparing outcome measures, which this study addresses. METHODS: This is a retrospective, comparative study of patients who underwent minimally invasive, 1-level TLIF or DLIF between 2013 and 2015. Only patients 18 years and older were included. Preoperative and demographic variables were collected, and clinical outcome measures were compared between cohorts. RESULTS: In total, 46 patients were included (DLIF: 17 patients; TLIF: 29 patients). Preoperatively, there was no difference in visual analog scale pain score or Oswestry Disability Index. Overall, there was a significant improvement in the postoperative visual analog scale score and Oswestry Disability Index in the separate cohorts, without significant difference when compared. The duration of postoperative narcotic use was similar in both cohorts (DLIF: 4.8 ± 4.7 months vs. TLIF: 5.2 ± 5.1 months, P = 0.82). Significantly more patients in DLIF cohort were cleared for work after surgery. Patients who underwent MIS TLIF had a significantly longer time to return to work (7.1 ± 4.8 months) compared with patients undergoing DLIF (2.3 ± 1.3, P = 0.006). There was a greater incidence of reoperation in the TLIF cohort. CONCLUSIONS: Both MIS TLIF and DLIF provide long-term improvement in pain andfunctional outcomes, with an overall reduction in postoperative narcotic requirement. However, there was a significantly longer time to return to work and a greater incidence of reoperation in the TLIF cohort compared with the patients who underwent DLIF.

Medical Subject Headings

Aged; Cohort Studies; Female; Humans; Lumbar Vertebrae (diagnostic imaging, surgery); Male; Middle Aged; Minimally Invasive Surgical Procedures (methods, trends); Narcotics (therapeutic use); Neurodegenerative Diseases (diagnostic imaging, psychology, surgery); Pain, Postoperative (drug therapy, psychology); Quality of Life (psychology); Retrospective Studies; Return to Work (trends); Spinal Fusion (methods, trends); Treatment Outcome

Publication Date

8-1-2018

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

116

First Page

e321

Last Page

e328

PubMed ID

29738856

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.04.201

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