A new article published in Neurosurgery compares secondary fusion rates for open and minimally invasive decompressions.
The study authors examined literature published in Pubmed/MEDLINE that separately reported outcomes for lumbar spinal stenosis and degenerative spondylolisthesis patients treated with open laminectomies or minimally invasive unilateral laminotomy. The analysis included 37 studies, 19 with open laminectomy and 18 with minimally invasive unilateral laminotomy. The studies covered 1,156 patients and were published from 1983 to 2015.
The study authors found:
1. Most of the literature was weak evidence — Level III or Level IV.
2. The secondary fusion rate after open laminectomy was 12.8 percent; after the minimally invasive procedure the secondary fusion rate was 3.3 percent.
3. For the open procedure, the total reoperation rate was 16.3 percent, compared with 5.8 percent for the minimally invasive procedure.
4. None of the procedures in the minimally invasive study cohort reported a slip in progression; 72 percent of the studies with the open procedure cohort did.
5. Patient satisfaction after the open procedure was 62.7 percent, while patient satisfaction for the minimally invasive procedure was 76 percent.
"In patients with LSS and DS, minimally invasive decompression is associated with lower reoperation and fusion rates, less slip progression and greater patient satisfaction than open surgery," concluded the study authors. "Therefore, MIL is not only a good alternative to laminectomy, in selected patients, it might even be a more cost-effective alternative to fusion surgery with a lower complication rate."