664 Use of Local Surgical Site Morselized Autograph to Perform Minimally Invasive Transforaminal Lumbar Interbody Fusion to Improve Outcome

Abstract

INTRODUCTION: MI-TLIF has become one of the primary approaches for treating refractory low back pain. Patient outcomes are related to fusion rates. A critical analysis of the impact of surgical site morselized autograph bone (MAB) on patient reported outcomes undergoing MI-TLIF has not been analyzed. METHODS: A retrospective analysis of 215 patients who underwent MI-TLIF using MAB. Variables analyzed included age, gender, follow-up period, comorbidities, number/levels of stenosis, estimated blood loss, surgical time, complications in the immediate postoperative period, clinical scales including VAS (Visual Analogue Scale), ODI (Oswestry Disability Index) at 3, 6, 12, 24 -months. RESULTS: Average age was 63.8±12.7 years and average BMI was 29.4±6.1 kg/m2 with average follow-up 19.4+/-11.4 months. Co-morbidities included: diabetes (n=34 (15.8%)) and current or former smoker (n = 61 (28.4%)). Pathogy treated included 156 patients with spondylolisthesis (n = 139, grade 1; n = 17, grade 2) and 122 patients with concomitant stenosis with grade 1(n = 20), 2(n = 15), and 3(n = 87). No major operative adverse events were noted, with 2 patients with postoperative infections. Postoperative VAS showed statistically significant improvements at 3 weeks, 1 year, and 2 years compared to baseline levels (p < 0.00001 for all). Improvements in ODI scores were statistically significant compared to baseline at 3 months (p = 0.03) and 2 years (p = 0.016). Of the 54 patients that had comorbid scoliosis, Cobb angle improved from 20±10.6 preoperatively to 16 ± 10.5 postoperatively (p = 0.27). No long-term adverse events occurred. Fusion rate was greater than 95%. CONCLUSIONS: MI-TLIF using MAB was highly cost effective, had low complication rates, and significantly improved patient reported outcomes.