Circumferential fusion with open versus percutaneous posterior fusion for lumbar isthmic spondylolisthesis.
Publication/Presentation Date
10-1-2021
Abstract
STUDY DESIGN: Retrospective cohort study.
OBJECTIVE: To investigate the clinical and radiographic differences between patients who underwent anterior lumber interbody fusion (ALIF) with either open or percutaneous posterior fusion for lumbar isthmic spondylolisthesis.
SUMMARY OF BACKGROUND DATA: Circumferential fusion for isthmic spondylolisthesis is commonly performed with superior clinical outcomes, fusion rates, and restoration of sagittal balance when compared to posterior fusion alone. The outcomes comparing traditional open versus percutaneous posterior fusion in this setting have not been fully evaluated.
METHODS: A retrospective review of patients who underwent ALIF with either traditional open or percutaneous posterior fusion for isthmic spondylolisthesis between 2014 and 2019 was conducted. Patient demographics, surgical characteristics, and radiographic and clinical outcomes were compared between groups.
RESULTS: A total of 79 patients were included in the final analysis, with 49 in the Open group and 30 in the Percutaneous group. No differences were found with regard to demographic factors between groups including sex, body mass index (BMI), diabetic status, and smoking status. The percutaneous group had less estimated blood loss (EBL, 69.2 mL) and shorter length of stay (3.06 days) compared to the open group (446 mL, p = 0.017; 3.98 days, p = 0.003). Both groups demonstrated significant improvement in all clinical outcome measures after surgery (PCS-12, MCS-12, ODI, VAS Back, and VAS Leg scores). The percutaneous group achieved greater ∆VAS Back (Open = 3.55, Perc = 5.17; p = 0.045) and also had a significantly greater improvements in recovery ratio for VAS Back (Open: 0.43, Perc: 0.73; p = 0.037) and ODI (Open: 0.40, Perc = 0.67; p = 0.031). Regression analysis demonstrated percutaneous surgery to be significant predictor of superior improvement in VAS Back scores (β = 1.957, p = 0.027).
CONCLUSION: ALIF with percutaneous posterior fusion affords greater improvement in back pain and disability when compared to ALIF with open posterior fusion for isthmic spondylolisthesis.
LEVEL OF EVIDENCE: III.
Volume
209
First Page
106935
Last Page
106935
ISSN
1872-6968
Published In/Presented At
Karamian, B. A., Conaway, W. K., Mao, J. Z., Canseco, J. A., Levy, H. A., Lee, J. K., Hilibrand, A. S., Kepler, C. K., Vaccaro, A. R., & Schroeder, G. D. (2021). Circumferential fusion with open versus percutaneous posterior fusion for lumbar isthmic spondylolisthesis. Clinical neurology and neurosurgery, 209, 106935. https://doi.org/10.1016/j.clineuro.2021.106935
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
34560384
Department(s)
Administration and Leadership
Document Type
Article