Improvement following minimally invasive transforaminal lumbar interbody fusion in patients aged 70 years or older compared with younger age groups

Pratyush ShahiDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Sidhant DalalDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Daniel ShinnDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Junho SongDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Kasra AraghiDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Dimitra MelissaridouDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Evan ShehaDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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James DowdellDepartment of Spine Surgery, Hospital for Special Surgery, New York; and

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Sravisht IyerDepartment of Spine Surgery, Hospital for Special Surgery, New York; and
Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York

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Sheeraz A. QureshiDepartment of Spine Surgery, Hospital for Special Surgery, New York; and
Department of Orthopedic Surgery, Weill Cornell Medical College, New York, New York

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OBJECTIVE

The goal of this study was to assess the outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients ≥ 70 years old and compare them to younger age groups.

METHODS

This was a retrospective study of data that were collected prospectively. Patients who underwent primary single-level MI-TLIF were included and divided into 3 groups: age < 60, 60–69, and ≥ 70 years. The outcome measures were as follows: 1) patient-reported outcome measures (PROMs) (i.e., visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]); 2) minimum clinically important difference (MCID) achievement; 3) return to activities; 4) opioid discontinuation; 5) fusion rates; and 6) complications/reoperations.

RESULTS

A total of 147 patients (age < 60 years, 62; 60–69 years, 47; ≥ 70 years, 38) were included. All the groups showed significant improvements in all PROMs at the early (< 6 months) and late (≥ 6 months) time points and there was no significant difference between the groups. Although MCID achievement rates for VAS leg and ODI were similar, they were lower in the ≥ 70-year-old patient group for VAS back and SF-12 PCS. Although the time to MCID achievement for ODI and SF-12 PCS was similar, it was greater in the ≥ 70-year-old patient group for VAS back and leg. There was no significant difference between the groups in terms of return to activities, opioid discontinuation, fusion rates, and complication/reoperation rates.

CONCLUSIONS

Although patients > 70 years of age may be less likely and/or take longer to achieve MCID compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.

ABBREVIATIONS

ASA = American Society of Anesthesiologists ; BMI = body mass index ; CCI = Charlson Comorbidity Index ; EBL = estimated blood loss ; LOS = length of stay ; MCID = minimum clinically important difference ; MI-TLIF = minimally invasive TLIF ; ODI = Oswestry Disability Index ; PROMs = patient-reported outcome measures ; SF-12 PCS = 12-Item Short-Form Health Survey Physical Component Summary ; TLIF = transforaminal lumbar interbody fusion ; VAS = visual analog scale.

OBJECTIVE

The goal of this study was to assess the outcomes of minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in patients ≥ 70 years old and compare them to younger age groups.

METHODS

This was a retrospective study of data that were collected prospectively. Patients who underwent primary single-level MI-TLIF were included and divided into 3 groups: age < 60, 60–69, and ≥ 70 years. The outcome measures were as follows: 1) patient-reported outcome measures (PROMs) (i.e., visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]); 2) minimum clinically important difference (MCID) achievement; 3) return to activities; 4) opioid discontinuation; 5) fusion rates; and 6) complications/reoperations.

RESULTS

A total of 147 patients (age < 60 years, 62; 60–69 years, 47; ≥ 70 years, 38) were included. All the groups showed significant improvements in all PROMs at the early (< 6 months) and late (≥ 6 months) time points and there was no significant difference between the groups. Although MCID achievement rates for VAS leg and ODI were similar, they were lower in the ≥ 70-year-old patient group for VAS back and SF-12 PCS. Although the time to MCID achievement for ODI and SF-12 PCS was similar, it was greater in the ≥ 70-year-old patient group for VAS back and leg. There was no significant difference between the groups in terms of return to activities, opioid discontinuation, fusion rates, and complication/reoperation rates.

CONCLUSIONS

Although patients > 70 years of age may be less likely and/or take longer to achieve MCID compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.

Approximately one-third of the current United States population older than 70 years suffers from diagnosed spinal degeneration. 1 An increase of 62% was seen in the volume of elective lumbar fusions in the United States between 2004 and 2105. 2 Increasing life expectancy combined with a preference for an active lifestyle is expected to increase the size of the elderly population seeking surgical care for degenerative pathology of the spine. Minimally invasive techniques have been reported to decrease intraoperative blood loss and injury to the surrounding tissues, and this may be particularly beneficial in the elderly. 39

Lumbar fusion is a more invasive procedure compared to decompression alone because it frequently involves instrumentation and placement of an interbody cage. 1012 Patients, especially the elderly, naturally have queries regarding its outcomes, speed of recovery, and the risk-benefit ratio. Although these questions cannot always be answered accurately, an appropriate explanation as part of surgical counseling can help in setting realistic expectations in terms of outcomes.

Transforaminal lumbar interbody fusion (TLIF) is regarded as a workhorse technique for the treatment of degenerative conditions of the lumbar spine. 13 Although various studies have been previously conducted to assess the outcomes of minimally invasive TLIF (MI-TLIF) in the elderly, 1318 only a few have reported minimum clinically important difference (MCID) achievement rates, 17,18 and none have reported the time taken to achieve MCID, return to activities, and discontinue opioids postoperatively. Therefore, the purpose of this comparative study was to fill this gap in the literature by assessing the MCID achievement, return to activities, and opioid discontinuation, in addition to analyzing the improvement in patient-reported outcome measures (PROMs), fusion rates, and complication/reoperation rates in patients ≥ 70 years old following MI-TLIF.

Methods

Study Design and Patient Population

This was an institutional review board–approved retrospective cohort study that was exempt from the informed consent requirement. Patients who underwent primary single-level MI-TLIF (Qureshi-Louie class 2) 19 for the treatment of degenerative conditions of the lumbar spine between April 2017 and February 2021 and who had a minimum of 1-year follow-up were included. Revision and multilevel surgeries were excluded. Surgeries were performed by fellowship-trained spine surgeons with practices dedicated mainly to minimally invasive spine surgery. The included patients were divided into 3 groups based on age: < 60 years, 60–69 years, and ≥ 70 years.

Surgical Technique

MI-TLIF was performed as previously described in the literature, 2027 by using a tubular retractor with unilateral facetectomy, preparation of the disc space, interbody cage placement, and a bilateral percutaneous pedicle screw construct.

Data Collection

The following data were collected and managed using REDCap (Research Electronic Data Capture) 28,29 hosted at Weill Cornell Medicine Clinical and Translational Science Center, supported by the National Center for Advancing Translational Science of the National Institutes of Health (award no. UL1 TR002384), as follows.

  1. 1.Preoperative: demographics (age, sex, body mass index [BMI], age-adjusted Charlson Comorbidity Index [CCI], American Society of Anesthesiologists [ASA] class) and PROMs (visual analog scale [VAS] for back and leg pain, Oswestry Disability Index [ODI], and 12-Item Short-Form Health Survey Physical Component Summary [SF-12 PCS]).
  2. 2.Operative: operative time, estimated blood loss (EBL), and complications.
  3. 3.Postoperative: postoperative length of stay (LOS), PROMs, return to work and driving, discontinuation of opioids, complications/reoperations, and fusion rates. Data were collected at the postoperative time points of 2 weeks, 6 weeks, 12 weeks, 6 months, 1 year, and 2 years, and two postoperative time points (early [< 6 months] and late [≥ 6 months]) were defined for analysis. Fusion status was assessed on the 1-year postoperative CT scan as described previously in the literature.30 Fusion was defined as bony bridging from endplate to endplate within the cage as well as lateral to the cage.

Statistical Analysis

Differences in demographics and operative variables between the 3 groups were analyzed with the 1-way ANOVA/Kruskal-Wallis and chi-square tests. PROMs were analyzed for improvements following surgery. Paired t-tests were performed to analyze the changes in postoperative VAS back, VAS leg, ODI, and SF-12 PCS compared to the preoperative baseline. One-way ANOVA tests were performed to assess the differences between the 3 groups in preoperative PROMs and the magnitude of improvement. The proportion of patients achieving MCID for these PROMs was calculated. The following MCID-threshold values were used: 12.8 for ODI, 1.2 for VAS back, 1.6 for VAS leg, and 4.9 for SF-12 PCS. 31 Time to MCID achievement was calculated. The percentage of patients returning to activities and discontinuing opioids and the average time to do so were analyzed. Significance was defined at p ≤ 0.05, and IBM SPSS version 25 (IBM Corp.) was used to perform all analyses.

Results

Demographic, Operative, and Perioperative Variables

A total of 147 patients (age < 60 years: 62 patients, 60–69 years: 47 patients, ≥ 70 years: 38 patients) were included. Significant differences between the 3 groups were seen in age-adjusted CCI (0.8 vs 2.7 vs 4, p < 0.001) and ASA class (p = 0.006). No significant difference was seen in sex, BMI, operative time, EBL, and postoperative LOS (Table 1).

TABLE 1.

Comparison of demographic and operative variables between the 3 groups

Group 1, <60 YrsGroup 2, 60–69 YrsGroup 3, ≥70 Yrsp Value
OverallGroup 1 vs 3Group 1 vs 2Group 2 vs 3
No. of pts624738
Age (in yrs)47.9 ± 8.7464.38 ± 3.1974.65 ± 5.38
Sex0.479
 Female34 (54.8%)21 (44.7%)17 (44.7%)
 Male28 (45.2%)26 (55.3%)21 (55.3%)
BMI (in kg/m2)28.32 ± 5.929.14 ± 8.0227.03 ± 5.10.33
Age-adjusted CCI0.75 ± 0.782.7 ± 0.974.02 ± 1.38<0.001<0.001<0.001<0.001
ASA class0.006
 I12 (19.3%)1 (2.1%)1 (2.6%)
 II48 (77.4%)40 (85.1%)34 (89.5%)
 III2 (3.2%)6 (12.7%)3 (7.9%)
Op time (in mins)106.93 ± 36.48126.42 ± 109.05111.26 ± 57.380.091
EBL (in mL)63.15 ± 103.7761.38 ± 42.6158.16 ± 43.750.949
Postop LOS (in hrs)40.52 ± 28.835.83 ± 22.0232.9 ± 19.910.301

Pts = patients.

Values are shown as the number of patients (%) or the mean ± SD unless otherwise indicated. Boldface type indicates statistical significance.

Improvement in PROMs

No significant difference was found between the 3 groups in any of the PROMs at the preoperative and the early (< 6 months) and late (≥ 6 months) postoperative time points. Each of the 3 groups showed significant improvements in all PROMs at both time points compared to the preoperative baseline (Table 2).

TABLE 2.

Improvement in PROMs compared to the preoperative values at the early (< 6 months) and late (≥ 6 months) postoperative time points

<60 Yrs60–69 Yrs≥70 Yrsp Value
VAS back
 Preop5.83 ± 2.995.86 ± 2.574.84 ± 3.180.247
 Early2.95 ± 2.68 (p < 0.001)2.68 ± 2.35 (p < 0.001)1.8 ± 2.07 (p < 0.001)0.098
 Late2.61 ± 2.79 (p < 0.003)2.4 ± 2.31 (p < 0.001)2.14 ± 2.67 (p = 0.003)0.753
VAS leg
 Preop5.25 ± 3.335.98 ± 3.045.56 ± 3.010.561
 Early2.17 ± 2.54 (p < 0.001)2.1 ± 2.55 (p < 0.001)1.88 ± 2.19 (p < 0.001)0.863
 Late2.16 ± 3.03 (p < 0.001)1.87 ± 2.55 (p < 0.001)1.59 ± 2.08 (p < 0.001)0.653
ODI
 Preop39.52 ± 17.0433.26 ± 17.5437.07 ± 19.270.256
 Early23.57 ± 19.21 (p < 0.001)21.31 ± 16.74 (p = 0.001)18.86 ± 15.5 (p < 0.001)0.475
 Late17.90 ± 18.28 (p < 0.001)13.53 ± 13.9 (p < 0.001)17.6 ± 16.83 (p < 0.001)0.454
SF-12 PCS
 Preop32.87 ± 10.3334.11 ± 9.6933.88 ± 8.560.82
 Early38.74 ± 11.28 (p = 0.001)40.31 ± 10.54 (p = 0.007)39.79 ± 9.83 (p = 0.005)0.79
 Late43.38 ± 12.39 (p < 0.001)47.24 ± 10.7 (p < 0.001)40.42 ± 11.46 (p = 0.008)0.096

Boldface type indicates statistical significance.

Comparison of the Magnitude of Improvement in PROMs Between the 3 Groups

No significant difference was found between the groups in the magnitude of improvement in any of the PROMs at either time point (Table 3).

TABLE 3.

Comparison of the magnitude of improvement in PROMs between the 3 groups at the early (< 6 months) and late (≥ 6 months) postoperative time points

<60 Yrs60–69 Yrs≥70 Yrsp Value
VAS back
 Early−2.94 ± 3.47−3.35 ± 3.18−2.79 ± 3.140.754
 Late−2.66 ± 3.69−3.28 ± 3.3−2.29 ± 3.580.540
VAS leg
 Early−3.22 ± 3.5−3.88 ± 3.7−3.45 ± 3.50.697
 Late−2.64 ± 3.61−3.88 ± 3.63−3.83 ± 3.540.227
ODI
 Early−16.78 ± 17.94−12.93 ± 21.74−17.58 ± 21.040.581
 Late−18.78 ± 17.46−18.89 ± 17.68−16.82 ± 21.130.867
SF-12 PCS
 Early6.2 ± 12.786.11 ± 11.945.97 ± 10.690.997
 Late9.31 ± 14.0613.17 ± 10.966.37 ± 11.60.134

MCID Achievement

Although the MCID achievement rates for VAS leg and ODI were similar for the 3 groups, they were comparatively lower in the ≥ 70-year-old patient group for VAS back at the early and late time points (55% and 48% vs 65%–76%) and SF-12 PCS at the late time point (46% vs 64% and 74%) (Table 4). Although time to MCID achievement for ODI and SF-12 PCS was similar (approximately 4 months) in the 3 groups, it was comparatively greater in the ≥ 70-year-old patient group for VAS back (2.5 months vs 1.2 and 1.5 months) and VAS leg (1.8 months vs 0.9 and 1.2 months) (Table 5) (Fig. 1).

TABLE 4.

MCID achievement rates at the early (< 6 months) and late (≥ 6 months) postoperative time points

<60 Yrs60–69 Yrs≥70 Yrs
VAS back
 Early68.6%75.7%54.8%
 Late65.2%67.6%48.1%
VAS leg
 Early62.7%75.7%64.5%
 Late58.7%64.7%70.4%
ODI
 Early62.7%51.4%51.6%
 Late63.8%61.8%59.3%
SF-12 PCS
 Early54.9%56.8%54.8%
 Late63.8%73.5%46.4%
TABLE 5.

Time to MCID achievement for PROMs

<60 Yrs60–69 Yrs≥70 Yrs
VAS back1.2 mos1.5 mos2.5 mos
VAS leg0.9 mos1.2 mos1.8 mos
ODI4.1 mos4.2 mos3.7 mos
SF-12 PCS4.4 mos4.2 mos3.8 mos
FIG. 1.
FIG. 1.

Graph showing time in months (y-axis) to MCID achievement for PROMs.

Return to Activities and Discontinuation of Opioids

Overall, 98% of patients who had previously driven returned to driving (average 19 days), 80% of previously working patients returned to work (average 18 days), and 97% of patients discontinued opioid use postoperatively (average 10 days). No significant difference was seen between the groups (Table 6).

TABLE 6.

Percentage of patients returning to driving/working and discontinuing opioid use postoperatively and the average time to achieve it

<60 Yrs60–69 Yrs≥70 Yrsp Value
Return to driving100%, 21 days96%, 19 days96%, 16 days0.329, 0.142
Return to work81%, 21 days74%, 14 days86%, 16 days0.754, 0.253
Opioid discontinuation98%, 12 days93%, 7 days93%, 10 days0.479, 0.212

The p values are for comparisons of percentage of patients and number of days, respectively.

Fusion Rates

Evidence of fusion could be assessed in only 70 of 147 patients due to the unavailability of postoperative CT scans for the remaining individuals. There was no significant difference between the groups in the fusion rates (age < 60 years: 89.3%, 60–69 years: 86.4%, ≥ 70 years: 85%; p = 0.901).

Complications/Reoperations

The groups showed no significant difference in complication/reoperation rates (Table 7). No surgery-related mortality was reported in any of the groups.

TABLE 7.

Complication and reoperation rates in the 3 groups

Complication<60 Yrs60–69 Yrs≥70 Yrs
Intraop01 (2.1%) durotomy0
Immediate postop6 (9.7%)2 (4.2%)3 (7.9%)
4 urinary retention 2 urinary retention 1 urinary retention
2 nausea/vomiting 2 nausea/vomiting
Reops7 (11.3%)1 (2.1%)2 (5.2%)
1 screw revision 1 ASD 1 pseudarthrosis
3 pseudarthrosis 1 ASD
1 ASD
1 painful hardware
1 SSI
Other complications3 (4.8%) minor wound complication3 (6.4%) minor wound complication1 (2.6%) minor wound complication

ASD = adjacent-segment disease; SSI = surgical site infection.

Discussion

This study evaluated the impact of age on the outcomes of MI-TLIF. The analysis reveals that patients > 70 years of age had lower rates of MCID achievement for back pain and physical function, and took longer to achieve MCID for back pain and leg pain. However, age was not significantly associated with the overall degree of improvement in PROMs, return to activities, discontinuation of opioids, fusion rates, and complication/reoperation rates.

Our study assessed PROMs by using the VAS for back and leg pain, ODI, and SF-12 PCS surveys, and we found significant improvements in all PROMs in all 3 groups at both early and late time points. Additionally, no significant difference could be demonstrated between the groups in the magnitude of improvement in any PROM at either postoperative time point. A recent study conducted by Goh et al. similarly demonstrated global improvement in PROMs after MI-TLIF in both the ≥ 70-year-old and < 70-year-old patient groups, with no significant difference in the magnitude of improvement between the groups. 17 Two similar studies also demonstrated good clinical outcomes following MI-TLIF irrespective of age. 13,14 These findings of comparable outcomes across age groups emphasize the advantage of the use of minimally invasive techniques for lumbar fusion in the elderly. Previously, Glassman et al. had demonstrated that following open TLIF, older patients may have worse outcomes compared to younger patients. 32 Takahashi et al. had similarly concluded that the clinical benefits of open TLIF in patients older than 70 years were limited compared to the younger patients. 33

Although the overall magnitude of improvement in PROMs did not differ across groups, a difference was noted in MCID achievement rates for back pain and physical function. Compared to their younger counterparts, a lower proportion of patients > 70 years of age achieved MCID for VAS back at the early and late time points (approximately 50% vs 65%–76%) and SF-12 PCS at the late time point (46% vs 64%–74%). Although the time to MCID achievement for disability and physical function was similar (approximately 4 months) across groups, it was comparatively longer for the ≥ 70-year-old group for back pain (2.5 months vs 1.2 and 1.5 months) and leg pain (1.8 months vs 0.9 and 1.2 months). Goh et al. had previously demonstrated no significant difference in MCID achievement rates between the ≥ 70-year-old and < 70-year-old patient groups following MI-TLIF for degenerative spondylolisthesis. 17 Another study also reported similar MCID achievement across age groups (age < 65 years, 65–74 years, ≥ 75 years), except for VAS leg at 6 weeks and 12 weeks. 18 The current study showed no significant difference between the groups in terms of return to activities and discontinuation of opioids postoperatively. No previous study had analyzed the impact of age on these variables following MI-TLIF.

The complication/reoperation rates following MI-TLIF reported in this study are similar to what has been previously described in the literature. A meta-analysis conducted by Jin-Tao et al. had shown a complication rate of 13%. 15 The current study found no major differences in the complication/reoperation rates between the 3 groups, suggesting that age independently is not a risk factor for complications following MI-TLIF. Mohan et al. similarly demonstrated no significant difference in the complication rates following MI-TLIF among 3 different age cohorts (< 65 years, 65–74 years, ≥ 75 years). 18 Patel et al. showed that although postoperative complications not affecting outcome were frequently seen in patients > 65 years of age, there was no significant difference in terms of neurological or cardiopulmonary events based on age. 14

All 3 age groups had statistically similar rates of fusion at 1 year, ranging from 85% to 90%. A meta-analysis by Wu et al. reported a mean fusion rate of 94% following MI-TLIF. 34 A retrospective cohort study by Lin et al., similar to the current study, reported a higher fusion rate in the younger age group of < 65 years (95%) versus the older age group of ≥ 65 years (85%), although their findings were not statistically significant, after single-level MI-TLIF. 13 More recently, Goh et al. demonstrated no significant difference in fusion rates based on age (87% for patients < 70 years and 90% for patients ≥ 70 years; p = 0.135). 17

This study has several limitations. It was a single-institution study, which reduces its generalizability. Patients who were lost to follow-up were not included, which introduces selection bias. There can also be an inherent bias in selecting the "healthy" older patients because some patients, especially in the ≥ 70-year-old group, might not have been medically fit to undergo a fusion procedure. The retrospective study design limits the level of evidence, but the data were prospectively collected, which mitigates recall bias. The inclusion of only 1-level MI-TLIFs limits the generalizability to multilevel surgeries and other types of lumbar interbody fusion. Variables like psychosocial factors, degree of degenerative changes, and difference in CCI between the groups may have contributed to the reported findings but were not accounted for in the analysis. The < 60-year-old cohort did not have a lower age limit, so the youngest patients may have skewed the data in that cohort. The inclusion of patients with a minimum of 1-year and a maximum of 2-year follow-up warrants future studies to assess long-term outcomes. Last, postoperative CT scans done at 1 year to assess evidence of fusion were available for only approximately half of the patients. Also, the 1-year period may not be enough to determine failure of fusion.

Conclusions

Although patients > 70 years of age may be less likely to achieve MCID for back pain and physical function and may take longer to achieve MCID for back and leg pain compared to their younger counterparts, they show an overall significant improvement in PROMs, a similar likelihood of returning to activities and discontinuing opioids, and comparable fusion and complication/reoperation rates following MI-TLIF.

Disclosures

Dr. Sheha reported personal fees from TheraCell outside the submitted work. Dr. Iyer reported personal fees from Stryker Corp., Healthgrades, and Globus Medical, Inc., outside the submitted work; ownership interest in HS2, LLC; and research support from Innovasis. Dr. Qureshi reported ownership/equity/investment in Tissue Differentiation Intelligence; he also reported personal fees from the following: Stryker K2M (royalties from intellectual property, designer, consultant); SpineGuard, Inc. (consultant); Globus Medical, Inc. (royalties from intellectual property, speakers’ bureau, consultant); Simplify Medical, Inc. (clinical event committee); AMOpportunities (honoraria); Surgalign (consultant); Viseon, Inc. (research support [either personally or through the Hospital for Special Surgery], consultant); HS2, LLC (ownership/equity/investment); LifeLink.com Inc. (medical or scientific advisory board membership); Spinal Simplicity, LLC (medical or scientific advisory board membership); and Contemporary Spine Surgery (editorial board) outside the submitted work. Dr. Qureshi also reported the following. North American Spine Society (NASS)—1) Political Engagement Committee member, 2) Payor Policy Review Committee member, 3) SpinePAC Advisory Committee member, and 4) CME Committee member. Annals of Translational Medicine (ATM)—Editorial Board. Hospital Special Surgery Journal—Editorial Board/Senior Associate Editor (2021–2024). Society of Minimally Invasive Spine Surgery (SMISS)—1) Program Committee member, 2) 2018 Annual Meeting Program chair, 3) Board of Directors (2021–2024), 4) Professional Society member of Directors/Trustees/Governors/Managers, member at large, or committee member. Lumbar Spine Research Society (LSRS)—1) Website Committee member (2020–2022), 2) Professional Society member of Directors/Trustees/Governors/Managers, member at large, or committee member. Cervical Spine Research Society (CSRS)—1) Publications Committee member (2019–2022), 2) Professional Society member. Minimally Invasive Spine Study Group Board of Directors—Treasurer. Association of Bone and Joint Surgeons (ABJS)—1) Program Committee member, 2) Professional Society member. International Society for the Advancement of Spine Surgery (ISASS)—1) Education Committee, 2) Program Committee, 3) 2021 Annual Meeting Program chair, 4) Professional Society member.

Author Contributions

Conception and design: Qureshi, Shahi, Shinn, Araghi, Sheha, Dowdell, Iyer. Acquisition of data: Qureshi, Shahi, Song, Araghi, Melissaridou, Sheha, Dowdell. Analysis and interpretation of data: Shahi, Dalal, Shinn, Song, Araghi, Melissaridou, Sheha, Dowdell, Iyer. Drafting the article: Shahi, Dalal, Song, Araghi. Critically revising the article: Qureshi, Shahi, Dalal, Shinn, Dowdell, Iyer. Reviewed submitted version of manuscript: Qureshi, Shahi, Dalal, Song, Sheha, Dowdell, Iyer. Approved the final version of the manuscript on behalf of all authors: Qureshi. Statistical analysis: Shahi, Shinn, Dowdell. Administrative/technical/material support: Qureshi. Study supervision: Qureshi, Sheha, Dowdell, Iyer.

References

  • 1

    Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep. 2021;11(1):5389.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.Spine (Phila Pa 1976). 2019;44(5):369376.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Shahi P, Song J, Dalal S, et al. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine. 2022;37(6):828835.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Shahi P, Vaishnav AS, Mai E, et al. Practical answers to frequently asked questions in minimally invasive lumbar spine surgery. Spine J. Published online July 14, 2022. doi:10.1016/j.spinee.2022.07.087

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Mok JK, Gang CH, Qureshi S, McAnany SJ. Using minimally invasive techniques adds to the value equation for select patients. J Spine Surg. 2019;5(suppl 1):S101-S107.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Vaishnav AS, Othman YA, Virk SS, Gang CH, Qureshi SA. Current state of minimally invasive spine surgery. J Spine Surg. 2019;5(suppl 1):S2-S10.

  • 7

    Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015;3(1):19.

  • 8

    Skovrlj B, Belton P, Zarzour H, Qureshi SA. Perioperative outcomes in minimally invasive lumbar spine surgery: a systematic review. World J Orthop. 2015;6(11):9961005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Othman YA, Alhammoud A, Aldahamsheh O, Vaishnav AS, Gang CH, Qureshi SA. Minimally invasive spine lumbar surgery in obese patients: a systematic review and meta-analysis. HSS J. 2020;16(2):168176.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Verma R, Virk S, Qureshi S. Interbody fusions in the lumbar spine: a review. HSS J. 2020;16(2):162167.

  • 11

    Virk S, Qureshi S, Sandhu H. History of spinal fusion: where we came from and where we are going. HSS J. 2020;16(2):137142.

  • 12

    Virk S, Qureshi S. Current concepts in spinal fusion: a special issue. HSS J. 2020;16(2):106107.

  • 13

    Lin GX, Quillo-Olvera J, Jo HJ, et al. Minimally invasive transforaminal lumbar interbody fusion: a comparison study based on end plate subsidence and cystic change in individuals older and younger than 65 years. World Neurosurg. 2017;106:174184.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Patel JY, Kundnani VG, Chawada B. Is older age a contraindication for single-level transforaminal lumbar interbody fusion? Asian Spine J. 2021;15(4):447454.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Jin-Tao Q, Yu T, Mei W, et al. Comparison of MIS vs. open PLIF/TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta-analysis. Eur Spine J. 2015;24(5):10581065.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Huang J, Rabin EE, Stricsek GP, Swong KN. Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis. J Neurosurg Spine. 2022;36(5):741752.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Goh GS, Tay YWA, Liow MHL, et al. Elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion may have similar clinical outcomes, perioperative complications, and fusion rates as their younger counterparts. Clin Orthop Relat Res. 2020;478(4):822832.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Mohan S, Cha EDK, Lynch CP, Geoghegan CE, Jadczak CN, Singh K. Impact of advanced age on postoperative outcomes following transforaminal lumbar interbody fusion. J Am Acad Orthop Surg. 2021;29(17):e869e879.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Louie PK, Vaishnav AS, Gang CH, et al. Development and initial internal validation of a novel classification system for perioperative expectations following minimally invasive degenerative lumbar spine surgery. Clin Spine Surg. 2021;34(9):E537E544.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Vaishnav AS, Merrill RK, Sandhu H, et al. A review of techniques, time demand, radiation exposure, and outcomes of skin-anchored intraoperative 3D navigation in minimally invasive lumbar spinal surgery. Spine (Phila Pa 1976). 2020;45(8):E465E476.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Shahi P, Vaishnav A, Araghi K, et al. Robotics reduces radiation exposure in minimally invasive lumbar fusion compared with navigation. Spine (Phila Pa 1976). 2022;47(18):12791286.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Lovecchio FC, Vaishnav AS, Steinhaus ME, et al. Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion? Neurosurg Focus. 2020;49(3):E17.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Shahi P, Vaishnav AS, Melissaridou D, et al. Factors causing delay in discharge in patients eligible for ambulatory lumbar fusion surgery. Spine (Phila Pa 1976). 2022;47(16):11371144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Kumar A, Merrill RK, Overley SC, et al. Radiation exposure in minimally invasive transforaminal lumbar interbody fusion: the effect of the learning curve. Int J Spine Surg. 2019;13(1):3945.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Vaishnav AS, Gang CH, Qureshi SA. Time-demand, radiation exposure and outcomes of minimally invasive spine surgery with the use of skin-anchored intraoperative navigation: the effect of the learning curve. Clin Spine Surg. 2022;35(1):E111E120.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Shafi KA, Pompeu YA, Vaishnav AS, et al. Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery? Neurosurg Focus. 2022;52(1):E4.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Shahi P, Shinn D, Singh N, et al. ODI <25 denotes patient acceptable symptom state after minimally invasive lumbar spine surgery. Spine (Phila Pa 1976). Published online September 16, 2022. doi:10.1097/BRS.0000000000004479

    • Search Google Scholar
    • Export Citation
  • 28

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377381.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Overley SC, McAnany SJ, Anwar MA, et al. Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells. Int J Spine Surg. 2019;13(1):4652.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am. 2008;90(9):18391847.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Takahashi T, Hanakita J, Minami M, et al. Clinical outcomes and adverse events following transforaminal interbody fusion for lumbar degenerative spondylolisthesis in elderly patients. Neurol Med Chir (Tokyo). 2011;51(12):829835.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Wu RH, Fraser JF, Härtl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976). 2010;35(26):22732281.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Collapse
  • Expand

Illustration from Chan et al. (E2). © Andrew K. Chan, published with permission.

  • View in gallery
    FIG. 1.

    Graph showing time in months (y-axis) to MCID achievement for PROMs.

  • 1

    Parenteau CS, Lau EC, Campbell IC, Courtney A. Prevalence of spine degeneration diagnosis by type, age, gender, and obesity using Medicare data. Sci Rep. 2021;11(1):5389.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2

    Martin BI, Mirza SK, Spina N, Spiker WR, Lawrence B, Brodke DS. Trends in lumbar fusion procedure rates and associated hospital costs for degenerative spinal diseases in the United States, 2004 to 2015.Spine (Phila Pa 1976). 2019;44(5):369376.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Shahi P, Song J, Dalal S, et al. Improvement following minimally invasive lumbar decompression in patients 80 years or older compared with younger age groups. J Neurosurg Spine. 2022;37(6):828835.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Shahi P, Vaishnav AS, Mai E, et al. Practical answers to frequently asked questions in minimally invasive lumbar spine surgery. Spine J. Published online July 14, 2022. doi:10.1016/j.spinee.2022.07.087

    • Search Google Scholar
    • Export Citation
  • 5

    Mok JK, Gang CH, Qureshi S, McAnany SJ. Using minimally invasive techniques adds to the value equation for select patients. J Spine Surg. 2019;5(suppl 1):S101-S107.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Vaishnav AS, Othman YA, Virk SS, Gang CH, Qureshi SA. Current state of minimally invasive spine surgery. J Spine Surg. 2019;5(suppl 1):S2-S10.

  • 7

    Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases. 2015;3(1):19.

  • 8

    Skovrlj B, Belton P, Zarzour H, Qureshi SA. Perioperative outcomes in minimally invasive lumbar spine surgery: a systematic review. World J Orthop. 2015;6(11):9961005.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Othman YA, Alhammoud A, Aldahamsheh O, Vaishnav AS, Gang CH, Qureshi SA. Minimally invasive spine lumbar surgery in obese patients: a systematic review and meta-analysis. HSS J. 2020;16(2):168176.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10

    Verma R, Virk S, Qureshi S. Interbody fusions in the lumbar spine: a review. HSS J. 2020;16(2):162167.

  • 11

    Virk S, Qureshi S, Sandhu H. History of spinal fusion: where we came from and where we are going. HSS J. 2020;16(2):137142.

  • 12

    Virk S, Qureshi S. Current concepts in spinal fusion: a special issue. HSS J. 2020;16(2):106107.

  • 13

    Lin GX, Quillo-Olvera J, Jo HJ, et al. Minimally invasive transforaminal lumbar interbody fusion: a comparison study based on end plate subsidence and cystic change in individuals older and younger than 65 years. World Neurosurg. 2017;106:174184.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Patel JY, Kundnani VG, Chawada B. Is older age a contraindication for single-level transforaminal lumbar interbody fusion? Asian Spine J. 2021;15(4):447454.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Jin-Tao Q, Yu T, Mei W, et al. Comparison of MIS vs. open PLIF/TLIF with regard to clinical improvement, fusion rate, and incidence of major complication: a meta-analysis. Eur Spine J. 2015;24(5):10581065.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 16

    Huang J, Rabin EE, Stricsek GP, Swong KN. Outcomes and complications of minimally invasive transforaminal lumbar interbody fusion in the elderly: a systematic review and meta-analysis. J Neurosurg Spine. 2022;36(5):741752.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Goh GS, Tay YWA, Liow MHL, et al. Elderly patients undergoing minimally invasive transforaminal lumbar interbody fusion may have similar clinical outcomes, perioperative complications, and fusion rates as their younger counterparts. Clin Orthop Relat Res. 2020;478(4):822832.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Mohan S, Cha EDK, Lynch CP, Geoghegan CE, Jadczak CN, Singh K. Impact of advanced age on postoperative outcomes following transforaminal lumbar interbody fusion. J Am Acad Orthop Surg. 2021;29(17):e869e879.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Louie PK, Vaishnav AS, Gang CH, et al. Development and initial internal validation of a novel classification system for perioperative expectations following minimally invasive degenerative lumbar spine surgery. Clin Spine Surg. 2021;34(9):E537E544.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Vaishnav AS, Merrill RK, Sandhu H, et al. A review of techniques, time demand, radiation exposure, and outcomes of skin-anchored intraoperative 3D navigation in minimally invasive lumbar spinal surgery. Spine (Phila Pa 1976). 2020;45(8):E465E476.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Shahi P, Vaishnav A, Araghi K, et al. Robotics reduces radiation exposure in minimally invasive lumbar fusion compared with navigation. Spine (Phila Pa 1976). 2022;47(18):12791286.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Lovecchio FC, Vaishnav AS, Steinhaus ME, et al. Does interbody cage lordosis impact actual segmental lordosis achieved in minimally invasive lumbar spine fusion? Neurosurg Focus. 2020;49(3):E17.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Shahi P, Vaishnav AS, Melissaridou D, et al. Factors causing delay in discharge in patients eligible for ambulatory lumbar fusion surgery. Spine (Phila Pa 1976). 2022;47(16):11371144.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Kumar A, Merrill RK, Overley SC, et al. Radiation exposure in minimally invasive transforaminal lumbar interbody fusion: the effect of the learning curve. Int J Spine Surg. 2019;13(1):3945.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Vaishnav AS, Gang CH, Qureshi SA. Time-demand, radiation exposure and outcomes of minimally invasive spine surgery with the use of skin-anchored intraoperative navigation: the effect of the learning curve. Clin Spine Surg. 2022;35(1):E111E120.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Shafi KA, Pompeu YA, Vaishnav AS, et al. Does robot-assisted navigation influence pedicle screw selection and accuracy in minimally invasive spine surgery? Neurosurg Focus. 2022;52(1):E4.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Shahi P, Shinn D, Singh N, et al. ODI <25 denotes patient acceptable symptom state after minimally invasive lumbar spine surgery. Spine (Phila Pa 1976). Published online September 16, 2022. doi:10.1097/BRS.0000000000004479

    • Search Google Scholar
    • Export Citation
  • 28

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377381.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Overley SC, McAnany SJ, Anwar MA, et al. Predictive factors and rates of fusion in minimally invasive transforaminal lumbar interbody fusion utilizing rhBMP-2 or mesenchymal stem cells. Int J Spine Surg. 2019;13(1):4652.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 31

    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY. Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J. 2008;8(6):968974.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32

    Glassman SD, Copay AG, Berven SH, Polly DW, Subach BR, Carreon LY. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am. 2008;90(9):18391847.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 33

    Takahashi T, Hanakita J, Minami M, et al. Clinical outcomes and adverse events following transforaminal interbody fusion for lumbar degenerative spondylolisthesis in elderly patients. Neurol Med Chir (Tokyo). 2011;51(12):829835.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34

    Wu RH, Fraser JF, Härtl R. Minimal access versus open transforaminal lumbar interbody fusion: meta-analysis of fusion rates. Spine (Phila Pa 1976). 2010;35(26):22732281.

    • Crossref
    • Search Google Scholar
    • Export Citation

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