Abstract
Background: Different surgical approaches are available for lumbar interbody fusion (LIF) to treat disc degeneration. However, a quantification of their invasiveness is lacking, and the definition of minimally invasive surgery (MIS) has not been biochemically detailed. We aimed at characterizing the inflammatory, hematological, and clinical peri-surgical responses to different LIF techniques. Methods: 68 healthy subjects affected by single-level discopathy (L3 to S1) were addressed to MIS, anterior (ALIF, n = 21) or lateral (LLIF, n = 23), and conventional approaches, transforaminal (TLIF, n = 24), based on the preoperative clinical assessment. Venous blood samples were taken 24 h before the surgery and 24 and 72 h after surgery to assess a wide panel of inflammatory and hematological markers. Results: martial (serum iron and transferrin) and pro-angiogenic profiles (MMP-2, TWEAK) were improved in ALIF and LLIF compared to TLIF, while the acute phase response (C-reactive protein, sCD163) was enhanced in LLIF. Conclusions: MIS procedures (ALIF and LLIF) associated with a reduced incidence of post-operative anemic status, faster recovery, and enhanced pro-angiogenic stimuli compared with TLIF. LLIF associated with an earlier activation of innate immune mechanisms than ALIF and TLIF. The trend of the inflammation markers confirms that the theoretically defined mini-invasive procedures behave as such.
Highlights
Invasive surgery (MIS) techniques rapidly gained attention in surgical practice thanks to the significant advantage in reducing tissue exposure and trauma
The technological advances acquired have allowed the application of different minimally invasive surgery (MIS) procedures to a wide range of conditions [1], but the more common use of MIS is in interbody fusion for the treatment of back pain [5], and sagittal [6] and coronal malalignment correction [7]
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Summary
Invasive surgery (MIS) techniques rapidly gained attention in surgical practice thanks to the significant advantage in reducing tissue exposure and trauma. The “body” is the biggest vertebra portion and the greatest area for fusion and, biomechanically, the majority of the load goes through the vertebral body For this reason, the interbody fusion represents a pivotal point to obtain high fusion rates and good clinical outcomes. Several approaches are used for lumbar interbody fusion (LIF) in MIS (anterior (ALIF), lateral (LLIF), or eXtreme-lateral (XLIF) [4]) and conventional open procedures (posterior (PLIF) and transforaminal (TLIF)). Methods: 68 healthy subjects affected by single-level discopathy (L3 to S1) were addressed to MIS, anterior (ALIF, n = 21) or lateral (LLIF, n = 23), and conventional approaches, transforaminal (TLIF, n = 24), based on the preoperative clinical assessment. Conclusions: MIS procedures (ALIF and LLIF) associated with a reduced incidence of post-operative anemic status, faster recovery, and enhanced pro-angiogenic stimuli compared with TLIF. The trend of the inflammation markers confirms that the theoretically defined mini-invasive procedures behave as such
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