Research
This clinical study prospectively compares the results of open surgery to minimally invasive fusion for degenerative lumbar spine pathologies. Eighty-two patients were studied (41 minimally invasive surgery [MIS] spinal fusion, 41 open surgical equivalent) under a single surgeon (R. J. Mobbs). The two groups were compared using the Oswestry Disability Index, the Short Form-12 version 1, the Visual Analogue Scale score, the Patient Satisfaction Index, length of hospital stay, time to mobilise, postoperative medication and complications. The MIS cohort was found to have significantly less postoperative pain, and to have met the expectations of a significantly greater proportion of patients than conventional open surgery. The patients who underwent the MIS
- Department of Neurosurgery, University of New South Wales, High Street, Randwick, New South Wales, Australia
- Spine Unit, Prince of Wales Hospital, Barker Street, Randwick, New South Wales, Australia
- Neuro Spine Clinic, Suite 7a, Level 7 Prince of Wales Private Hospital, Barker Street, Randwick, New South Wales 2031, Australia
Summary
The safety of traditional open techniques for pedicle screw placement for spinal fixation is well documented.1,2 However, conventional open spine surgery has several limitations reported including extensive blood loss, postoperative muscle pain and infection risk. Paraspinal muscle dissection involved in open spine surgery can cause muscular denervation, increased intramuscular pressure, ischaemia, necrosis and revascularisation injury resulting in muscle atrophy and scarring which is associated with prolonged postoperative pain and disability.3–12 This approach-related morbidity is then often associated with lengthy hospital stays and significant costs.13 Spinal fusion utilising muscle dilating approaches to minimise surgical incision length, surgical cavity size and the amount of iatrogenic soft-tissue injury associated with surgical spinal exposure, without compromising outcomes, is thus a desirable advance.3–12
The current trend favours minimally invasive surgery (MIS) of the spine due to lower complication rates and approach-related morbidity with minimal soft tissue trauma, reduced intraoperative blood loss and risk of transfusion, improved cosmesis, decreased postoperative pain and narcotic usage, shorter hospital stays, earlier mobilisation with faster return to work and thus reduced overall health care costs.1,4,6–9,13–18 However, to our knowledge there is no quality published articles showing that MIS is superior to open spinal surgery. The aim of this study was to directly compare the effectiveness of MIS to conventional open spinal fusion, by assessing clinical outcomes and patient satisfaction.
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