Our Summary

This study aimed to compare two types of spinal surgery: minimally invasive surgery (MIS) and open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF). The researchers looked at past studies and data to see how effective each type of surgery was, how many complications occurred, and how patients recovered.

They found over 3,000 relevant studies, but only 26 of these met their criteria and were included in the review. These included a total of 1,662 patients who had undergone either MIS or open TLIF/PLIF.

The review found that patients who had minimally invasive surgery lost less blood during the operation, were able to start walking again sooner, and spent fewer days in hospital compared to those who had open surgery. However, the total operation time was similar for both types of surgery.

In terms of complications, the two types of surgery had similar rates of surgical complications but patients who had MIS were less likely to experience other medical complications. There was no difference between the two types of surgery in terms of the need for further surgery or the rate of non-healing of the fused bones.

When looking at disability scores (a measure of how much the back problem affected the patient’s life), those who had MIS had slightly better scores after two years.

In conclusion, the study found that minimally invasive surgery and open surgery for degenerative lumbar spinal disorders had similar outcomes in terms of patient-reported measures, but MIS had some advantages in terms of recovery and complications. However, the authors caution that the quality of the evidence is low and there could be biases in the studies included.

It’s important to note that the ultimate decision on the type of surgery should be based on the individual patient’s condition, the surgeon’s experience and preference, and a discussion of the potential benefits and risks.

FAQs

  1. What are the advantages of minimally invasive surgery (MIS) over open transforaminal or posterior lumbar interbody fusion (TLIF/PLIF)?
  2. Did the study find any differences in the rate of complications between minimally invasive surgery (MIS) and open TLIF/PLIF?
  3. What factors should be considered when deciding on the type of surgery for degenerative lumbar spinal disorders?

Doctor’s Tip

One helpful tip a doctor might tell a patient about lumbar fusion is to carefully follow post-operative instructions provided by the healthcare team. This may include restrictions on certain activities, proper wound care, and physical therapy exercises to aid in recovery and strengthen the back muscles. It is also important to attend follow-up appointments and communicate any concerns or changes in symptoms to your healthcare provider. By following these guidelines, patients can optimize their recovery and improve their overall outcome following lumbar fusion surgery.

Suitable For

Patients who are typically recommended for lumbar fusion surgery include those with severe back pain, leg pain, or weakness that has not improved with conservative treatments such as physical therapy, medications, or injections. Common conditions that may warrant lumbar fusion surgery include degenerative disc disease, spondylolisthesis, spinal stenosis, and herniated discs. Patients with instability or deformity of the spine may also be candidates for lumbar fusion.

Ultimately, the decision to undergo lumbar fusion surgery should be made in consultation with a spine surgeon who can evaluate the patient’s specific condition and recommend the most appropriate treatment option. The risks and benefits of surgery should be thoroughly discussed, and patients should have realistic expectations about the potential outcomes of the procedure.

Timeline

Overall, the timeline for a patient before and after lumbar fusion surgery can vary, but generally includes:

Before surgery:

  • Consultation with a spinal surgeon to discuss the procedure, risks, and benefits
  • Pre-operative tests and evaluations to assess the patient’s overall health and suitability for surgery
  • Preparation for surgery, which may include stopping certain medications, fasting, and arranging for post-operative care
  • Discussion of post-operative rehabilitation and recovery plan

During surgery:

  • The patient undergoes either minimally invasive surgery or open TLIF/PLIF, which involves fusing together two or more vertebrae in the lower back to stabilize the spine
  • The surgery typically takes several hours, with the patient under general anesthesia

After surgery:

  • The patient is monitored in the recovery room before being transferred to a hospital room
  • Pain management is provided to help with post-operative discomfort
  • Physical therapy and rehabilitation begin to help the patient regain mobility and strength in the back
  • The patient may need to stay in the hospital for a few days to a week, depending on the type of surgery and individual recovery
  • Follow-up appointments with the surgeon to monitor healing and address any concerns or complications
  • Over the following weeks and months, the patient gradually resumes normal activities and work, with ongoing rehabilitation as needed

Ultimately, the goal of lumbar fusion surgery is to reduce pain and improve function in patients with degenerative spinal conditions. The timeline for recovery and return to normal activities can vary depending on the individual patient’s condition, the type of surgery performed, and other factors.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lumbar fusion include:

  1. What are the differences between minimally invasive surgery and open TLIF/PLIF for lumbar fusion?
  2. What are the potential benefits of each type of surgery in terms of recovery time, complications, and outcomes?
  3. What are the potential risks and complications associated with each type of surgery?
  4. How experienced are you in performing each type of surgery?
  5. Are there any specific factors about my condition that make me a better candidate for one type of surgery over the other?
  6. What can I expect in terms of post-operative pain management, rehabilitation, and recovery time?
  7. Will I need further surgery in the future after undergoing lumbar fusion?
  8. What are the success rates and long-term outcomes for each type of surgery?
  9. Are there any alternative treatments or options to consider before undergoing lumbar fusion surgery?
  10. Can you provide me with any additional resources or information to help me make an informed decision about my treatment options?

Reference

Authors: Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Journal: J Neurosurg Spine. 2016 Mar;24(3):416-27. doi: 10.3171/2015.2.SPINE14973. Epub 2015 Nov 13. PMID: 26565767