Comparative Effectiveness of Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion

STUDY DESIGN: Retrospective cohort comparison between minimally invasive (MIS) and open transforaminal lumbar interbody fusion (TLIF). OBJECTIVE: To assess 2 earlier unstudied endpoints (duration of narcotic use and return to work) and long-term pain, disability, and quality of life (QOL) for MIS-TLIF versus open-TLIF. SUMMARY OF BACKGROUND DATA: MIS-TLIF for lumbar spondylolithesis theoretically allows for surgical treatment of back and leg pain while minimizing blood loss and tissue injury. Although earlier studies have shown shorter hospital stay and equivocal 6 and 24 month outcomes with MIS-TLIF versus open-TLIF, the effect of MIS techniques on postoperative narcotic use and return to work are poorly understood. METHODS: Thirty patients undergoing MIS-TLIF (n = 15) or open-TLIF (n = 15) for grade I degenerative spondylolithesis-associated back and leg pain were enrolled. Two-year outcomes were assessed through phone interview and it included pain visual analog scale (VAS), low-back disability (Oswestry disability index), EuroQol-5D, occupational disability, and narcotic use. RESULTS: MIS-TLIF versus open-TLIF cohorts were similar at baseline. Median interquartile range (IQR) length of hospitalization after surgery was significantly less for MIS-TLIF versus open-TLIF 3 (3 to 3) vs 5.5 (4 to 6) d, P = 0.001. MIS-TLIF versus open-TLIF patients showed similar 2-year improvement in VAS for back pain, VAS for leg pain, Oswestry disability index, and EuroQol-5D scores. Overall, median (IQR) length of postoperative narcotic use was 3.0 (1.4 to 4.6) weeks and significantly shorter for MIS-TLIF versus open-TLIF patients 2.0 (1.0 to 3.0) vs 4.0 (1.4 to 4.6) wk, P = 0.008. Overall, median (IQR) time to return to work was 13.9 (2.2 to 25.5) weeks and significantly shorter for MIS-TLIF versus open-TLIF patients 8.5 (4.4 to 21.4) vs 17.1 (1.8 to 35.9) wk, P = 0.02. CONCLUSIONS: Both MIS-TLIF and open-TLIF provide long-term improvement in pain, disability, and EuroQol-5D in patients with back and leg pain from grade I degenerative spondylolithesis. However, MIS-TLIF may allow for shortened hospital stays, reduced postoperative narcotic use, and accelerated return to work, reducing both direct medical costs and indirect costs of lost work productivity associated with TLIF procedures.