A study published in the Journal of Spinal Disorders and Techniques compares sagittal alignment for anterior, lateral and transforaminal approaches after lumbar interbody fusion.
There were 220 consecutive patients with 309 operative levels. The anterior approach was used at 184 levels; lateral approach at 86 levels; and transforaminal approach at 39 levels. The average follow up was 19.2 months. Here are five findings from the study:
1. The anterior and lateral groups significantly improved lordosis from preoperative to follow up. The anterior approach showed an average of 4.5 degrees improvement while the lateral approach showed 2.2 degrees improvement.
2. The transforaminal approach only showed 0.8 degrees lordois improvement from the preoperative visit to follow up. "After lumbar interbody fusion, improvement of lordosis was significant for both the anterior and lateral groups, but not the transforaminal group," concluded the study authors.
A previous study published in the Journal of Neurosurgery: Spine shows direct lateral interbody fusion significantly improves segmental, regional and global coronal plane alignment in patients with degenerative lumbar disease.
3. The anterior group significantly improved lordosis more than lateral or transforaminal groups, according to the intergroup analysis. A study published earlier this month in the Journal of Spinal Disorders and Techniques examining the sagittal spinopelvic alignment after posterior lumbar interbody fusion for patients with degenerative spondylolisthesis showed the procedure may be associated with improved sagittal spinopelvic alignment. "Surgeons should consider deformity parameters, especially SA, in the surgical treatment of degenerative spondylolisthesis," concluded the study authors.
4. Both the anterior and lateral groups showed significantly improved disc height. The anterior group showed 2.2mm disc height improvement; the lateral group showed 2mm improvement. The transforaminal group had 0.5mm disc height improvement on average.
5. All three groups significantly reduced spondylolisthesis, according to the study's abstract. There was no difference between groups. Hospital costs for lumbar interbody fusion are significant. A 2012 study published in the Journal of Spinal Disorders and Techniques shows the average length of stay for one-level minimally invasive surgery was 3.35 days, compared with 3.6 days for open surgery. One level procedures cost average $29,184 for the MIS procedure and $29,947 for the open procedure.
However, there is a bigger difference for two-level procedures. Patients in the two-level MIS group stayed in the hospital one less day than the open group and cost $33,879, compared to $35,984 in the open group.
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