Comparison of Clinical Outcomes in the National Neurosurgery Quality and Outcomes Database for Open Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion

Study Design.A retrospective database review.Objective.The aim of this study was to compare data on various pain and functional outcomes for patients who underwent minimally invasive transforaminal lumbar interbody fusion (MiTLIF) and those who had open TLIF to better delineate which patients may benefit from each procedure.Summary of Background Data.TLIF is a highly successful technique for the treatment of patients with degenerative instability or deformity. Minimally invasive approaches have been developed in an effort to improve outcomes by reducing tissue trauma and minimizing surgical time and blood loss. Although these approaches have been compared in the literature, there continues to be a debate about which patients may benefit from each procedure, and there is a dearth of information regarding short-term outcomes such as disposition status.Methods.We used the National Neurosurgery Quality and Outcomes Database (N2QOD) to assess outcomes of patients who underwent open or MiTLIF at a single institution from 2012 to 2014. Primary outcomes included Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores, and secondary outcomes included hospital length of stay, blood loss, discharge status, and return to work.Results.We identified 98 patients with 3- and 12-month follow-up records. The open and MiTLIF groups had similar improvements in ODI and VAS at 3 and 12 months. MiTLIF patients had a significantly longer hospital stay (5.0 vs. 3.8 days for open TLIF, P<0.001) and were more likely to discharge to a location other than home (P<0.021). Open TLIF patients had shorter mean operative time (235 vs. 329 minutes for MiTLIF, P<0.001) and more blood loss (307 vs. 120.2mL for MiTLIF, P<0.001).Conclusion.Although each approach demonstrated advantages and disadvantages, outcome measures at short-term follow-up were largely equivalent, suggesting that the selection of procedure should be based on which approach will offer the superior individual outcome.Level of Evidence: 4