Abstract
Purpose: The purpose of this study was to demonstrate the feasibility and early outcomes of one- and two-level lumbar decompression performed as an outpatient procedure.
Methods: A retrospective review was performed comparing lumbar “laminoplasty” (bilateral decompression from a unilateral approach) using a minimally invasive (MIS-group) technique (MetRxTM tubular retractor system) to open laminoplasty (Open Group). Comparison between groups was performed for patient demographics, radiographic and operative parameters, postoperative pain (VAS), analgesic use and adverse events.
Results: A total of 67 (Open–n=37/ MIS-n=30 [n=20: out patients] patient with a minimum follow-up of 6 months were analyzed. There was no statistically significant difference between groups for age, sex, BMI and radiographic parameters. The MIS group demonstrated a statistically significant reduction (mean = 24minutes) in operative time, estimated blood loss (63mls vs. 227mls), recovery room VAS scores (1.4 vs. 4.4) and total analgesic requirements by %50. None of the MIS group procedures performed on an outpatient basis required readmission. The length of stay for the n=10 inpatient MIS group (elderly patients) was also reduced compared to the open group (2.6 vs. 4.7 days, P= 0.035). The groups were comparable in operative and postoperative adverse events. No progression of preexisting spondylolisthesis has been noted in either group during the follow-up period. Furthermore, only one patient has required reoperation for mechanical low back pain in the MIS group and one patient for recurrent leg pain in the open group.
Conclusions: Minimally invasive outpatient decompression for 1–2 level spinal stenosis is feasible, provides acute perioperative patient and resource utilization benefits and appears to have comparable short-term clinical efficacy compared to open decompression. Long-term follow-up and validated outcomes assessments are currently being assessed.
Funding : Commerical funding
Funding Parties : Medtronic-Sofamor Danek
Correspondence should be addressed to Cynthia Vezina, Communications Manager, COA, 4150-360 Ste. Catherine St. West, Westmount, QC H3Z 2Y5, Canada
