J Neurol Surg A Cent Eur Neurosurg 2021; 82(05): 399-409
DOI: 10.1055/s-0040-1719099
Original Article

Retrospective Comparison of Minimally Invasive and Open Monosegmental Lumbar Fusion, and Impact of Virtual Reality on Surgical Planning and Strategy

1   Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Nordrhein-Westfalen, Germany
2   Department of Neurosurgery, Saint Barbara-Hospital Hamm-Heessen, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Nordrhein-Westfalen, Germany
,
Makoto Nakamura
3   Department of Neurosurgery, Academic Hospital Köln-Merheim, Witten/Herdecke University, Köln, Nordrhein-Westfalen, Germany
,
Christian Ewelt
2   Department of Neurosurgery, Saint Barbara-Hospital Hamm-Heessen, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Nordrhein-Westfalen, Germany
,
Konstantinos Kafchitsas
4   Department of Spine Surgery, Asklepios Orthopedic Hospital Lindenlohe, Schwandorf, Bayern, Germany
,
Marc Lewitz
2   Department of Neurosurgery, Saint Barbara-Hospital Hamm-Heessen, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Nordrhein-Westfalen, Germany
,
5   Department of Neurosurgery, University Hospital Münster, Münster, Nordrhein-Westfalen, Germany
,
Eric Suero Molina
5   Department of Neurosurgery, University Hospital Münster, Münster, Nordrhein-Westfalen, Germany
,
Antonio Santacroce
2   Department of Neurosurgery, Saint Barbara-Hospital Hamm-Heessen, Academic Hospital of Westfälische Wilhelms-University Münster, Hamm, Nordrhein-Westfalen, Germany
6   Department of Neurosurgery, Eberhard Karls University, Tübingen, Baden-Württemberg, Germany
,
Ralf Stroop
1   Department of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Nordrhein-Westfalen, Germany
› Author Affiliations

Abstract

Background and Study Aims Spinal fusion for symptomatic lumbar spondylolisthesis can be accomplished using an open or minimally invasive surgical (MIS) technique. Evaluation of segmental spondylolisthesis and instabilities and review of their therapies are inseparably connected with lumbar tomographic imaging. We analyzed a cohort of patients who underwent MIS or open monosegmental dorsal fusion and compared surgical outcomes along with complication rates. We furthermore evaluated the influence of virtual reality (VR) visualization on surgical planning in lumbar fusion.

Material and Methods Patient files were retrospectively analyzed regarding patient- and disease-related data, operative performance, surgical outcomes, and perioperative surgical complications. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans were retrospectively visualized via VR software. A questionnaire evaluated the influence of three-dimensional (3D) VR images versus two-dimensional CT and MRI scans on therapy planning, fusion method, and surgical technique and procedure.

Results Overall, 171 patients were included (MIS/open: 90/81). MIS was associated with less blood loss, shorter surgery time and hospital stay, lower complication rates, equivalent long-term patient-reported outcomes, but lower fusion rates and higher late reoperation rates than open surgery. Image presentation using VR significantly influenced the recommended surgical therapies (decompression only/decompression and fusion; p = 0.02), had no significant influence on the recommended fusion method (rigid/dynamic/stand-alone; p = 0.77), and, in cases of rigid fusion, a significant influence on the recommended technique (MIS/open; p = 0.03) and fusion procedure (p = 0.02).

Conclusion In patients with monosegmental degenerative or isthmic spondylolisthesis, MIS fusion was advantageous concerning perioperative complication rates and perioperative surgical outcomes, but disadvantageous regarding fusion and reoperation rates compared to open fusion. 3D-VR-based analysis of sectional images significantly influenced the recommended surgical planning.

Ethical Approval

The authors state that this study has been approved by the ethics commission of the Medical Faculty, Witten/Herdecke University (Ref-Nr. 201/2018) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


Informed Consent

The ethics commission of the Medical Faculty, Witten/Herdecke University (Ref-Nr. 201/2018) confirmed that formal consent is not required for this type of study.




Publication History

Received: 01 February 2020

Accepted: 12 May 2020

Article published online:
04 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE. Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine lumbar spine study. Spine 2005; 30 (08) 936-943
  • 2 Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J 2008; 8 (05) 747-755
  • 3 Patel AA, Zfass-Mendez M, Lebwohl NH. et al. minimally invasive versus open lumbar fusion: a comparison of blood loss, surgical complications, and hospital course. Iowa Orthop J 2015; 35: 130-134
  • 4 Gibson JN, Grant IC, Waddell G. The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine 1999; 24 (17) 1820-1832
  • 5 Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R. Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 2000; 93 (1, Suppl): 45-52
  • 6 Elmekaty M, Kotani Y, Mehy EE. et al. Clinical and radiological comparison between three different minimally invasive surgical fusion techniques for single-level lumbar isthmic and degenerative spondylolisthesis: minimally invasive surgical posterolateral fusion versus minimally invasive surgical transforaminal lumbar interbody fusion versus midline lumbar fusion. Asian Spine J 2018; 12 (05) 870-879
  • 7 Resnick DK, Watters WC, Sharan A. et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 9: lumbar fusion for stenosis with spondylolisthesis. J Neurosurg Spine 2014; 21 (01) 54-61
  • 8 Liu X, Wang Y, Qiu G, Weng X, Yu B. A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis. Eur Spine J 2014; 23 (01) 43-56
  • 9 Min J-H, Jang J-S, Lee S-H. Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis. J Neurosurg Spine 2007; 7 (01) 21-26
  • 10 Wu A-M, Chen C-H, Shen Z-H. et al. The outcomes of minimally invasive versus open posterior approach spinal fusion in treatment of lumbar spondylolisthesis: the current evidence from prospective comparative studies. BioMed Res Int 2017; 2017: 8423638
  • 11 Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar spine surgery. A histologic and enzymatic analysis. Spine 1996; 21 (08) 941-944
  • 12 Styf JR, Willén J. The effects of external compression by three different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans. Spine 1998; 23 (03) 354-358
  • 13 Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Comparative outcomes of minimally invasive surgery for posterior lumbar fusion: a systematic review. Clin Orthop Relat Res 2014; 472 (06) 1727-1737
  • 14 Wang J, Zhou Y, Zhang ZF, Li CQ, Zheng WJ, Liu J. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J 2010; 19 (10) 1780-1784
  • 15 Arts MP, Wolfs JF, Kuijlen JM, de Ruiter GC. Minimally invasive surgery versus open surgery in the treatment of lumbar spondylolisthesis: study protocol of a multicentre, randomised controlled trial (MISOS trial). BMJ Open 2017; 7 (11) e017882
  • 16 Kotani Y, Abumi K, Ito M, Sudo H, Abe Y, Minami A. Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis. Eur Spine J 2012; 21 (06) 1171-1177
  • 17 Lee KH, Yeo W, Soeharno H, Yue WM. Learning curve of a complex surgical technique: minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). J Spinal Disord Tech 2014; 27 (07) E234-E240
  • 18 Nandyala SV, Fineberg SJ, Pelton M, Singh K. Minimally invasive transforaminal lumbar interbody fusion: one surgeon's learning curve. Spine J 2014; 14 (08) 1460-1465
  • 19 Hartman J, Granville M, Jacobson RE. Radiologic evaluation of lumbar spinal stenosis: the integration of sagittal and axial views in decision making for minimally invasive surgical procedures. Cureus 2019; 11 (03) e4268
  • 20 Ong CS, Deib G, Yesantharao P. et al. Virtual reality in neurointervention. J Vasc Interv Neurol 2018; 10 (01) 17-22
  • 21 de Ribaupierre S, Eagleson R. Editorial: challenges for the usability of AR and VR for clinical neurosurgical procedures. Healthc Technol Lett 2017; 4 (05) 151
  • 22 Kawamata T, Iseki H, Shibasaki T, Hori T. Endoscopic augmented reality navigation system for endonasal transsphenoidal surgery to treat pituitary tumors: technical note. Neurosurgery 2002; 50 (06) 1393-1397
  • 23 Drouin S, Kochanowska A, Kersten-Oertel M. et al. IBIS: an OR ready open-source platform for image-guided neurosurgery. Int J CARS 2017; 12 (03) 363-378
  • 24 Molinari RW, Bridwell KH, Klepps SJ, Baldus C. Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 1999; 24 (10) 967-972
  • 25 Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25 (22) 2940-2952 , discussion 2952
  • 26 Spiker WR, Goz V, Brodke DS. Lumbar interbody fusions for degenerative spondylolisthesis: review of techniques, indications, and outcomes. Global Spine J 2019; 9 (01) 77-84
  • 27 Fedorov A, Beichel R, Kalpathy-Cramer J. et al. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging 2012; 30 (09) 1323-1341
  • 28 Fisher RA. On the interpretation of χ2 from contingency tables, and the calculation of P. J R Stat Soc 1922; 85 (01) 87-94
  • 29 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33 (01) 159-174
  • 30 Mummaneni PV, Bisson EF, Kerezoudis P. et al. Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis: analysis of the Quality Outcomes Database. Neurosurg Focus 2017; 43 (02) E11
  • 31 Sidhu GS, Henkelman E, Vaccaro AR. et al. Minimally invasive versus open posterior lumbar interbody fusion: a systematic review. Clin Orthop Relat Res 2014; 472 (06) 1792-1799
  • 32 Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine 2007; 32 (05) 537-543
  • 33 Xie L, Wu W-J, Liang Y. Comparison between minimally invasive transforaminal lumbar interbody fusion and conventional open transforaminal lumbar interbody fusion: an updated meta-analysis. Chin Med J (Engl) 2016; 129 (16) 1969-1986
  • 34 Suk SI, Lee CK, Kim WJ, Lee JH, Cho KJ, Kim HG. Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 1997; 22 (02) 210-219 , discussion 219–220
  • 35 Villavicencio AT, Burneikiene S, Roeca CM, Nelson EL, Mason A. Minimally invasive versus open transforaminal lumbar interbody fusion. Surg Neurol Int 2010; 1: 12
  • 36 Archavlis E, Carvi y Nievas M. Comparison of minimally invasive fusion and instrumentation versus open surgery for severe stenotic spondylolisthesis with high-grade facet joint osteoarthritis. Eur Spine J 2013; 22 (08) 1731-1740
  • 37 Lowe TG, Tahernia AD, O'Brien MF, Smith DAB. Unilateral transforaminal posterior lumbar interbody fusion (TLIF): indications, technique, and 2-year results. J Spinal Disord Tech 2002; 15 (01) 31-38
  • 38 Gelalis ID, Arnaoutoglou C, Christoforou G, Lykissas MG, Batsilas I, Xenakis T. Prospective analysis of surgical outcomes in patients undergoing decompressive laminectomy and posterior instrumentation for degenerative lumbar spinal stenosis. Acta Orthop Traumatol Turc 2010; 44 (03) 235-240
  • 39 Schwender JD, Holly LT, Rouben DP, Foley KT. Minimally invasive transforaminal lumbar interbody fusion (TLIF): technical feasibility and initial results. J Spinal Disord Tech 2005; 18 (Suppl): S1-S6
  • 40 Wood MJ, Mannion RJ. Improving accuracy and reducing radiation exposure in minimally invasive lumbar interbody fusion. J Neurosurg Spine 2010; 12 (05) 533-539
  • 41 Zawy Alsofy S, Stroop R, Fusek I. et al. Virtual reality-based evaluation of surgical planning and outcome of monosegmental, unilateral cervical foraminal stenosis. World Neurosurg 2019; 129: e857-e865