Surgical Invasiveness of Single-Segment Posterior Lumbar Interbody Fusion: Comparing Perioperative Blood Loss in Posterior Lumbar Interbody Fusion with Traditional Pedicle Screws, Cortical Bone Trajectory Screws, and Percutaneous Pedicle Screws

Study Design: Single-center retrospective study. Purpose: This study aims to evaluate the surgical invasiveness of single-segment posterior lumbar interbody fusion (PLIF) by comparing perioperative blood loss in PLIF with traditional pedicle screws (PS), cortical bone trajectory screws (CBT), and percutaneous pedicle screws (PPS). Overview of Literature: Intraoperative blood loss has often been used to evaluate surgical invasiveness. However, in patients undergoing spinal surgery, more blood loss is observed postoperatively than intraoperatively. Therefore, evaluating surgical invasiveness using only the intraoperative bleeding volume may result in considerable underestimation of the actual surgical invasiveness. Methods: This study included patients who underwent single-segment PLIF between January 2012 and December 2017. In total, seven patients underwent PLIF with PS (PS-PLIF), nine underwent PLIF with CBT (CBT-PLIF), and 15 underwent PLIF with PPS (PPS-PLIF). Results: No significant differences were noted in terms of operation time or intraoperative bleeding between the PS-PLIF, CBT-PLIF, and PPS-PLIF groups. However, the postoperative drainage volume in the PPS-PLIF group ( 210.1 mL; range, 50-367 mL) was determined to be significantly lower than that in the PS-PLIF (416.7 mL; range, 260-760 mL; p=0.002) and CBT-PLIF (421.1 mL; range, 180-890 mL; p=0.006) groups. In addition, the total amount of intraoperative bleeding and postoperative drainage was found to be significantly lower in the PPS-PLIF group (362.8 mL; range, 145-637 mL) than in the PS-PLIF (639.6 mL; range, 285-1,000 mL; p=0.01) and CBT-PLIF (606.7 mL; range, 270-950 mL; p=0.005) groups. Conclusions: Based on our findings, evaluating surgical invasiveness using only intraoperative bleeding can result in the underestimation of actual surgical invasiveness. Even with single-segment PLIF, the amount of perioperative bleeding can vary depending on the way the posterior instrument is installed.