Longer Operative Time Needed for Minimally Invasive Surgery
Minimally invasive surgery (MIS) may be slowly replacing traditional open operations for spinal fusion. Studies show less pain, muscle trauma, and blood loss with MIS. The hospital stay is shorter, thus reducing costs. Patients are able to return to normal activities and get back to work much faster.
In this comparison study, one surgeon looks at the results of posterior lumbar interbody fusion (PLIF) using both methods. All patients had low back pain (LBP) for more than six months. Conservative care during that time was not helpful.
Both procedures were described in detail. A very small incision (less than one inch) was made with the MIS method. A special imaging X-ray called a fluoroscope was used to see inside the spine. For the traditional operation, a three and a half inch incision was used. The muscles were cut and tools called retractors pulled the soft tissues apart.
Removing the disc and placing bone graft and interbody cages in place of the discs was the same for both groups. Data was collected on the patients for at least 12 months. X-rays were taken before surgery and two weeks, three months, six months, 12 months, and 24 months after surgery.
Clinical results were reported as follows:
No differences in age, gender, body mass index, or diagnosis between the groups
Much less blood loss during and after surgery with MIS (also less blood
MIS group could get up and walk sooner and left the hospital sooner
The MIS surgery took much longer compared to the open method
Pain was less in the MIS group but after one year, the results were the same between the groups
Fusion rate was the same between the groups
The authors conclude MIS gives favorable results but needs longer surgical time. The surgeon must pay close attention to prevent technical complications. Without the use of retractors, MIS reduces the risk of muscle and nerve damage. Doctors do not learn the MIS method in medical school. They must learn this later. It takes time and practice to operate safely using MIS.
Yung Park, MD, and Joong Won Ha, MD. Comparison of One-Level Posterior Lumbar Interbody Fusion Performed with a Minimally Invasive Approach or a Traditional Open Approach. In Spine. March 1, 2007. Vol. 32. No. 5. Pp. 537-543.