5-year Quality of Life improvement of MIS vs Open Transforaminal Lumbar Interbody Fusion for Grade 1 Spondylolisthesis: Propensity Score Matched Analysis using Quality Outcomes Database

Saturday, May 4, 2024

4:40 PM – 4:45 PM CT

Location: S401ab

Presenting Author(s)

Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US

Co-Author(s)

Ken Porche, MD

Spine Fellow
University of Utah
Salt Lake City, UT, US
Anthony L. Asher, MD

President AANS, Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, North Carolina, United States
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD, FAANS

Professor of Neurosurgery
Mayo Clinic
Rochester, MN, US
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, New York, United States
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Steven D. Glassman, MD (he/him/his)

Medical Director
Norton Leatherman Spine Center
Louisville, KY, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, GA, US
John Knightly, MD, FAANS (he/him/his)

Vice President
AANS
Cedar Knolls, NJ, US
Giorgos D. Michalopoulos, MD (he/him/his)

Resident
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, Minnesota, United States
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US
PP

Paul Park, MD

Professor of Neurosurgery
Semmes-Murphey Neurologic and Spine Institute
MEMPHIS, TN, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, VA, US
JS

Jonathan R. Slotkin, MD

Surgeon
Geisinger Health
Danville, Pennsylvania, United States
Cheerag Upadhyaya, MD, MBA (he/him/his)

Vice Chair of Outpatient Operations, Chief of Business Development and Strategy, Associate Professor of Neurosurgery
University of North Carolina
Chapel Hill, North Carolina, United States
MV

Michael S. Virk, MD, PhD

Assistant Professor
Weill Cornell Medical Center
New York, New York, United States
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US

Disclosure(s):

Eric Potts, MD: Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing)

Ken Porche, MD: No financial relationships to disclose

Anthony L. Asher, MD: Globus: Royalty Recipient (Ongoing)

Erica F. Bisson, MD, MPH: No financial relationships to disclose

Mohamad Bydon, MD, FAANS: No financial relationships to disclose

Andrew K. Chan, MD: No financial relationships to disclose

Dean Chou, MD: Cerapedics: Grant/Research Support (Ongoing); Cervical Scoliosis Research Society: Grant/Research Support (Ongoing); Globus Medical: Research Grant (Ongoing); Medtronic: Research Grant (Ongoing); Nuvasive: Research Grant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine Committee: Board Member/Officer/Trustee (Ongoing); Spinevision: Consultant (Ongoing); SpineWave: Consultant (Ongoing); Terumo: Consultant (Ongoing)

Domagoj Coric, MD: 3Spine: Stock Shareholder (excluding mutual funds) (Ongoing); Globus Medical: Royalty Recipient (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing); Premia Spine: Consultant (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); Pressio: Stock Shareholder (excluding mutual funds) (Ongoing); Spine Wave: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing)

Kevin T. Foley, MD: Accelus: Stock Shareholder (excluding mutual funds) (Ongoing); Discgenics: Stock Shareholder (excluding mutual funds) (Ongoing); DuraStat: Stock Shareholder (excluding mutual funds) (Ongoing); Medtronic: Consultant (Ongoing), Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); RevBio: Stock Shareholder (excluding mutual funds) (Ongoing); True Digital Surgery: Stock Shareholder (excluding mutual funds) (Ongoing); Vori Health: Stock Shareholder (excluding mutual funds) (Ongoing)

Kai-Ming Fu, MD, PhD: ATEC: Consultant (Terminated, December 1, 2023); Bioventus: Consultant (Ongoing); DePuy: Consultant (Ongoing)

Steven D. Glassman, MD: No financial relationships to disclose

Regis William Haid, MD, Jr.: Globus Medical: Royalty Recipient (Ongoing), Stock Shareholder (excluding mutual funds) (Ongoing); MDT: Royalty Recipient (Ongoing)

John Knightly, MD, FAANS: No financial relationships to disclose

Praveen V. Mummaneni, MD, MBA: AO Spine: Grant/Research Support (Ongoing); BK Medical: Speaker/Honoraria (Ongoing); Brainlab: Speaker/Honoraria (Ongoing); Depuy Synthes: Consultant (Ongoing); DOD: Research Grant (Ongoing); Globus: Consultant (Ongoing); ISSG: Grant/Research Support (Ongoing); NIH: Research Grant (Ongoing); NREF: Grant/Research Support (Ongoing); Pacira: Grant/Research Support (Ongoing); PCORI: Grant/Research Support (Ongoing); SI Bone: Speaker/Honoraria (Ongoing); SLIP II: Grant/Research Support (Ongoing); Springer Publisher: Royalty Recipient (Ongoing); Thieme Publisher: Royalty Recipient (Ongoing)

Paul Park, MD: Accelus: Consultant (Ongoing); Cerapedics: Grant/Research Support (Terminated, July 15, 2022); Depuy Spine: Consultant (Terminated, July 15, 2022), Grant/Research Support (Terminated, July 15, 2022); Globus Medical: Consultant (Ongoing), Royalty Recipient (Ongoing); ISSG: Grant/Research Support (Ongoing); Medtronic: Consultant (Ongoing); Nuvasive: Consultant (Ongoing); SI Bone: Grant/Research Support (Terminated, July 15, 2022); SMISS: Grant/Research Support (Ongoing)

Christopher I. Shaffrey, MD: No financial relationships to disclose

Mark Shaffrey, MD: No financial relationships to disclose

Cheerag Upadhyaya, MD, MBA: No financial relationships to disclose

Michael Y. Wang, MD: Depuy-Synthes: Consultant (Ongoing), Royalty Recipient (Ongoing); ISD: Stock Shareholder (excluding mutual funds) (Ongoing); Kinesiometrics: Stock Shareholder (excluding mutual funds) (Ongoing); Medical Device Partners: Stock Shareholder (excluding mutual funds) (Ongoing); NuVasive: Consultant (Ongoing); Pacira Pharmaceuticals: Consultant (Ongoing); Spineology: Consultant (Ongoing); Stryker: Consultant (Ongoing)

Introduction: In the past decade, minimally invasive (MIS) transforaminal interbody fusion (TLIF) has increased in popularity relative to the open counterpart. Proponents note decreased length of hospital stay, lower blood loss, and improved patient-reported outcomes. Long term quality of life improvement of TLIF relative to invasiveness has not been established. EQ-5D and calculated SF-6D were used to evaluate the 5-year quality of life improvement of MIS vs open TLIF.

Methods: From the Quality and Outcomes Database registry, 119 patients with grade 1 spondylolisthesis who underwent MIS-TLIF were propensity matched to patients who underwent open TLIF. Health-related quality of life measures and perioperative parameters were compared. Because health utility values derived from the SF-6D and EQ-5D questionnaires have been shown to vary in patients with low-back pain, quality-adjusted life years (QALYs) were derived from both measures. SF-6D was calculated based on NRSLP, NRSBP, and ODI.

Results: Operative time, hospital stay, and 3 year readmission and reoperation rates were similar for the MIS and open groups. MIS had 162 cc less EBL (p <.0001). Both MIS and Open TLIF significantly improved back and leg pain, Oswestry Disability Index scores, EQ-5D and calculated SF-6D scores at 1, 3, and 5 years postoperatively. At 5 years postoperatively, patients who had undergone MIS-TLIF had similar improvements in mean ODI scores (-25.7 vs -22.9, p = 0.273), mean calculated SF-6D scores (0.15 vs 0.13, p = 0.239), and mean EQ-5D scores (0.20 vs 0.20, p = 0.945) as patients treated with Open TLIF. Similar results were observed for subgroup of those without a related reoperation at 3 years.

Conclusion : Although MIS-TLIF offers certain advantages such as reduced blood loss, there are equivalent improvements in quality-of-life patient-reported outcomes compared to that of open TLIF.