215. A comparative analysis of single-level lumbar interbody fusion by approach and technique

Abstract

<h3>BACKGROUND CONTEXT</h3> In recent years spine surgeons have utilized different techniques and approaches to perform lumbar interbody fusion surgery. We sought to analyze the difference in outcomes between traditional open transforaminal lumbar interbody fusion (O-TLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), dual position anterior/lateral lumbar interbody fusion with posterior instrumentation (Dual ALIF/LLIF), and single position anterior/lateral lumbar interbody fusion with posterior instrumentation (Single ALIF/LLIF). <h3>PURPOSE</h3> To analyze the perioperative and postoperative outcomes of patient undergoing TLIF, MIS TLIF, Dual ALIF/LLIF, and Single ALIF/LLIF. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study at a single institution. <h3>PATIENT SAMPLE</h3> Patients undergoing O-TLIF, MIS TLIF, Dual ALIF/LLIF, or Single ALIF/LLIF from 2014 to 2020. <h3>OUTCOME MEASURES</h3> Operative time, estimated blood loss (EBL), length of stay (LOS), radiation dose, intraoperative and postoperative complications, and return to OR within 90 days. <h3>METHODS</h3> Patients who underwent single level lumbar interbody fusion surgery were analyzed. Patient charts were reviewed for operative time, EBL, LOS, radiation dose, intraoperative and postoperative complications, and return to OR within 90 days. Differences were assessed by ANOVA. <h3>RESULTS</h3> A total of 1,226 patients underwent a single level lumbar interbody fusion (440 O-TLIF, 423 MIS TLIF, 316 Dual ALIF/LLIF, 47 Single ALIF/LLIF). There were no significant differences in BMI or gender between the groups, but in the O-TLIF cohort average age (60) was higher than MIS-TLIF (54), Dual ALIF/LLIF(52), and Single ALIF/LLIF (50) p < 0.001. There were also significant differences in average operative time (221 mins O-TLIF, 212 mins MIS TLIF, 277 mins dual ALIF/LLIF, 277 mins single ALIF/LLIF, p < 0.001), EBL (360 ml O-TLIF, 167ml MIS TLIF, 235 ml Dual ALIF/LLIF, 253 ml Single ALIF/LLIF, p<0.001), radiation dose (20 mGy O-TLIF, 51 mGy MIS TLIF, 43 mGy Dual ALIF/LLIF, 62 mGy Single ALIF/LLIF, p < 0.001). There was no difference in LOS, intraoperative complications, or 90-day complications between the groups, except a higher rate of neurological deficit in dual ALIF/LLIF (1.6%, p < 0.03). Post hoc analysis demonstrated statistical significance in operative time in the Dual ALIF/LLIF as compared to all the other groups. O-TLIF demonstrated a larger EBL and less radiation as compared to all the other groups as well as a longer operative time than Single ALIF/LLIF. Dual ALIF/LLIF demonstrated a longer operative time and increased rate of neurological deficit as compared to MIS TLIF. <h3>CONCLUSIONS</h3> In comparing different techniques for single level lumbar interbody fusion there were similar outcomes in LOS, perioperative complications and 90-day complications between all the groups. Open TLIF was associated with increased estimate blood loss and less radiation than all the other groups Dual position ALIF/LLIF surgery was associated with a longer operative time than all the other groups. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.