(I-711) Surgical Complication Incidence Between [MIS_BDUL] and [Classic_Laminectomy] for Decompression in Lumbar Spinal Stenosis: Is Minimally Invasive Spine Surgery Always Superior?
Medical Student Central Michigan University College of Medicine
Introduction: Lumbar spine stenosis (LSS) remains one of the most presented spondylo-degenerative disorders to the spine clinics among the mid-age and elderly patients. Its management may involve conservative, alternative, open-surgical or minimally invasive surgical approaches. The invasiveness of an approach is inevitably associated with potential complications, particularly, in open surgical techniques. Value-based spine practice is rapidly becoming the epitome of care delivery in healthcare practice. The evaluation of complication outcomes from various studies and of heterogeneous sources on the management of LSS patients with minimally invasive unilateral laminotomy for bilateral decompression [MIS-BDUL] or classic laminectomy [Classic_Lami] can delineate safer surgical options based on the best given clinical evidence. The goal of this systematic review and meta-analysis was to investigate if LSS patients treated with [MIS-BDUL] showed overall better complication outcomes compared to those treated with [Classic_Lami].
Methods: A comprehensive literature review was performed from January 2000 to September 2021. The selection criteria for included studies comprised of the following: comparative of ≥10 patients, complication outcomes and a ≥1-year follow-up period. Outcomes compared between [MIS_BDUL] and [Classic_Lami] surgical approaches included: overall surgical complication incidence, intra-operative, immediate postoperative (defined as: < 2 weeks post-surgery), and later postoperative (defined as: ≥ 2 weeks post-surgery) surgical complications incidence. Statistical significance was set at (p < 0.05).
Results: Of the 372 LSS patients observed, 43.82% (n=163) and 56.18% (n=209) were [MIS_BDUL] and [Classic_Lami], respectively. Compared to [Classic_Lami] approach, the overall surgical complication outcome was significantly lower in the [MIS_BDUL] approach, [Odds Ratio (OR)= 0.51; 95% confidence interval (CI) = (0.28, 0.94); I2= 8%, (p=0.03)]. The incidence outcomes of dural tear, cerebrospinal fluid (CSF) leak, epidural hematoma, wound dehiscence/exploration, superficial or deep wound infections, chronic low back pain/failed back syndrome, re-operation after 2-week postoperative as well as the overall intraoperative, immediate postoperative, and later postoperative complication incidence were comparable between [MIS_BDUL] and [Classic_Lami] approaches, (p>0.05).
Conclusion : Our study indicates that LSS patients treated with [MIS_BDUL] approach significantly showed lesser overall surgical complication rates than those treated with [Classic_Lami] approach. Intraoperative, immediate, and later postoperative complication rates were comparable between [MIS_BDUL] and [Classic_Lami] approaches in LSS patients.
