MASTERS-D Study: A Prospective, Multicenter, Pragmatic, Observational, Data-Monitored Trial of Minimally Invasive Fusion to Treat Degenerative Lumbar Disorders, One-Year Follow-Up.

Jörg Franke,Khai Lam,Roberto Assietti,Neil Manson,Frederic Martens,Peter Durny,Wolfgang Senker,Zvi Lidar,David Buzek,Paulo Pereira,Ulrich Hubbe,Wout Rosenberg,Giovanni Barbanti Brodano,Kai Scheufler,Arkadiusz Kosmala

doi:10.7759/cureus.640

Abstract

The objective of the study is to assess effectiveness and safety of minimally invasive lumbar interbody fusion (MILIF) for degenerative lumbar disorders (DLD) in daily surgical practice and follow up with patients for one year after surgery.A prospective, multicenter, pragmatic, monitored, international outcome study in patients with DLD causing back/leg pain was conducted (19 centers). Two hundred fifty-two patients received standard of care available in the centers. Patients were included if they were aged >18 years, required one- or two-level lumbar fusion for DLD, and met the criteria for approved device indications. Primary endpoints: time to first ambulation (TFA) and time to surgery recovery (TSR). Secondary endpoints: patient-reported outcomes (PROs)--back and leg pain (visual analog scale), disability (Oswestry Disability Index (ODI)), health status (EQ-5D), fusion rates, reoperation rates, change in pain medication, rehabilitation, return to work, patient satisfaction, and adverse events (AEs). Experienced surgeons (≥30 surgeries pre-study) treated patients with DLD by one- or two-level MILIF and patients were evaluated for one year (NCT01143324).At one year, 92% (233/252) of patients remained in the study. Primary outcomes: TFA, 1.3 ±0.5 days and TSR, 3.2 ±2.0 days. Secondary outcomes: Most patients (83.3%) received one level MILIF; one (two-level) MILIF mean surgery duration, 128 (182) min; fluoroscopy time, 115 (154) sec; blood loss, 164 (233) mL; at one year statistically significant (P<.0001) and clinically meaningful changes from baseline were reported in all PROs--reduced back pain (2.9 ±2.5 vs. 6.2 ±2.3 at intake), reduced leg pain (2.2 ±2.6 vs. 5.9 ±2.8), and ODI (22.4% ± 18.6 vs. 45.3% ± 15.3), as well as health-related quality of life (EQ-5D index: 0.71 ±0.28 vs. 0.34 ±0.32). More of the professional workers were working at one year than those prior to surgery (70.3% vs. 55.2%). Three AEs and one serious AE were considered procedure-related; there were no deep site infections or deaths.This is the first study evaluating MILIF for treatment of DLD in daily clinical practice. Clinically significant improvements were observed in all endpoints. Short-term post-surgery improvements (four weeks) were maintained through one year with minimal complications. Our results suggest that MILIF has good-to-excellent outcomes for the treatment of DLD in a broad patient population under different clinical conditions and healthcare delivery systems.

Highlights

In the past 25 years, minimally invasive spine surgery (MIS) has emerged as an alternative to traditional open surgery to treat degenerative lumbar diseases (DLD)
We reported the one-year results of a pragmatic, multicenter, prospective, monitored study using minimally invasive fusion strategies in the daily surgical practice setting in 19 countries
Our results indicate that minimally invasive lumbar interbody fusion (MILIF) outcomes are in line with other reported surgical studies for the spine and provide valuable insights into the management of degenerative lumbar disorders (DLD) in the usual clinical practice

Summary

Introduction

In the past 25 years, minimally invasive spine surgery (MIS) has emerged as an alternative to traditional open surgery to treat degenerative lumbar diseases (DLD). Short-term benefits of MIS include reductions in intraoperative blood loss, postoperative pain, approach-related soft tissue damage and duration of hospital stay vs open methods. Long-term MIS studies have been associated with one or more of the following study limitations: low number of patients, surgeries performed at a single site using a single surgical technique, retrospective observational design, variability in reporting and surgeon learning curve [4, 6,7,8,9,10,11,12,13]. While available data suggests decreased morbidity and at least comparable outcomes vs open surgeries for the immediate and short-term postoperative period [14], there is limited data to support the long-term superiority of MIS over open techniques [3]

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