A comparison of narcotic usage and length of post-operative hospital stay in open versus minimally invasive lumbar interbody fusion with percutaneous pedicle screws

Abstract

Background: Instrumented lumbar fusion can be accomplished through open or minimally invasive techniques. The focus of this study was to compare perioperative narcotic usage and length of hospital stay between patients undergoing open versus minimally invasive spinal surgery (MISS). Methods: A retrospective chart review was performed on 110 patients who underwent instrumented lumbar fusion over 2 years at our institution. These patients were divided into two groups: those that received open transforaminal interbody fusion (n=69), and those whose surgeries were performed minimally invasively with lateral lumbar transpsoas interbody fusion (LLIF) and percutaneous pedicle screws (n=41). Narcotic usage was recorded for both groups intra-operatively and post-operatively throughout their hospital stay. These values were standardized using an equianalgesia chart. Results: Average narcotic usage post-operatively was significantly lower for the LLIF group relative to those who underwent open lumbar fusion (278.48 vs. 442.06 mg, P=0.03). The average length of post-operative hospital stay was significantly shorter for patients who underwent LLIF compared to those who had an open procedure (4.10 vs. 6.19 days, P=0.02). Conclusions: Patients who underwent minimally invasive surgery (MIS) LLIF had decreased overall use of opioids in the perioperative period and shorter hospital stays when compared to patients who underwent the open transforaminal interbody fusion approach. These findings support pre-existing literature in favor of LLIF MISS with regards to the above stated outcome measures. The long-term benefits of MISS with regards to narcotic usage in spine patients are not yet known.