Index episode-of-care propensity-matched comparison of transforaminal lumbar interbody fusion (TLIF) techniques: open traditional TLIF versus midline lumbar interbody fusion (MIDLIF) versus robot-assisted MIDLIF

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OBJECTIVE

Posterior fixation with interbody cage placement can be accomplished via numerous techniques. In an attempt to expedite recovery by limiting muscle dissection, midline lumbar interbody fusion (MIDLIF) has been described. More recently, the authors have developed a robot-assisted MIDLIF (RA-MIDLIF) technique. The purpose of this study was to compare the index episode-of-care (iEOC) parameters between patients undergoing traditional open transforaminal lumbar interbody fusion (tTLIF), MIDLIF, and RA-MIDLIF.

METHODS

A retrospective review of a prospective, multisurgeon surgical database was performed. Consecutive patients undergoing 1- or 2-level tTLIF, MIDLIF, or RA-MIDLIF for degenerative lumbar conditions were identified. Patients in each cohort were propensity matched based on age, sex, smoking status, BMI, diagnosis, American Society of Anesthesiologists (ASA) class, and number of levels fused. Index EOC parameters such as length of stay (LOS), estimated blood loss (EBL), operating room (OR) time, and actual, direct hospital costs for the index surgical visit were analyzed.

RESULTS

Of 281 and 249 patients undergoing tTLIF and MIDLIF, respectively, 52 cases in each cohort were successfully propensity matched to the authors’ first 55 RA-MIDLIF cases. Consistent with propensity matching, there was no significant difference in age, sex, BMI, diagnosis, ASA class, or levels fused. Spondylolisthesis was the most common indication for surgery in all cohorts. The mean total iEOC was similar across all cohorts. Patients undergoing RA-MIDLIF had a shorter average LOS (1.53 days) than those undergoing either MIDLIF (2.71 days) or tTLIF (3.58 days). Both MIDLIF and RA-MIDLIF were associated with lower EBL and less OR time compared with tTLIF.

CONCLUSIONS

Despite concerns for additional cost and time while introducing navigation or robotic technology, a propensity-matched comparison of the authors’ first 52 RA-MIDLIF surgeries with tTLIF and MIDLIF showed promising results for reducing OR time, EBL, and LOS without increasing cost.

ABBREVIATIONS ASA = American Society of Anesthesiologists; CBT = cortical bone trajectory; EBL = estimated blood loss; iEOC = index episode of care; LOS = length of stay; MIDLIF = midline lumbar interbody fusion; OR = operating room; RA = robot-assisted; TLIF = transforaminal lumbar interbody fusion; tTLIF = traditional open TLIF.
Article Information

Contributor Notes

Correspondence Mikhail Lew P. Ver: Norton Leatherman Spine Center, Louisville, KY. miko.ver@gmail.com.INCLUDE WHEN CITING Published online January 24, 2020; DOI: 10.3171/2019.9.SPINE1932.Disclosures Dr. Gum: employee of Norton Healthcare; consultant for Medtronic, DePuy, Acuity, K2M, PacMed, and NuVasive; direct stock ownership in Cingulate Therapeutic; clinical or research support for this study from Intellirod, Integra, Pfizer, and International Spine Study; and royalties from Acuity. Dr. Crawford: consultant for Alphatec, DePuy Synthes, Medtronic, and NuVasive. Dr. Djurasovic: consultant for Medtronic and NuVasive. Dr. Owens: consultant for Medtronic and NuVasive; and support of non–study-related clinical or research effort from Pfizer, Intellirod, and Texas Scottish Rite Hospital. Dr. Brown: employee of Norton Healthcare. Dr. Carreon: employee of Norton Healthcare; consultant for AOSpine; funds for travel from the University of Southern Denmark and University of Louisville; institutional research funds from OREF, NIH, ISSG, SRS, TSRH, Pfizer, and Cerapedics; member of the editorial advisory board for Spine Deformity, The Spine Journal, and Spine; member of University of Louisville IRB; and research committee of SRS.
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