title: Effect of minimally invasive technique on return to work and narcotic use following transforaminal lumbar inter-body fusion: a review.
abstract: OBJECTIVE
  Low back pain is one of the most prevalent and disabling musculoskeletal conditions affecting the working population in the United States. Informed, shared decision making among patients, clinicians, and case managers about treatment options for chronic low back pain-including the role of spinal fusion where medically necessary-can have a meaningful impact on return to work, normal function, and economic outcomes. Minimally invasive techniques for lumbar spinal fusion, including transforaminal lumbar interbody fusion (MIS TLIF) have recently been introduced with the goal of smaller operative wounds, less tissue trauma, and faster postoperative recovery when compared with open fusion. Although similar long-term clinical outcomes have been reported for MIS TLIF and open TLIF, the relative merits with respect to workplace productivity have not been comprehensively investigated. Time to return to work and narcotic independence after MIS TLIF and open TLIF are important parameters that may affect overall workplace productivity, and as such are the focus of this study.
  
  
  METHODS
  This study was performed via a review of the literature.
  
  
  METHODS
  We performed a systematic literature review to identify all published articles that reported on the postoperative outcomes of patients, as assessed by return to work or narcotic independence status or both, following MIS TLIF or open TLIF. A cumulative comparison was made for all included MIS TLIF versus open TLIF surgeries.
  
  
  RESULTS
  Seventy-four published studies reported postoperative outcomes following MIS TLIF or open TLIF; only five (6.8%) studies directly described time to return to work or duration of narcotic use postoperatively or both, and were therefore included into the analysis of this review. Four studies in the published literature describe time to return to work following MIS TLIF or open TLIF, and two studies describe time to narcotic independence. Overall, the reviewed literature suggests that MIS TLIF may be associated with an accelerated time to narcotic independence and return to work versus open TLIF.
  
  
  CONCLUSIONS
  There are limited data regarding time to return to work and duration of postoperative narcotic use following TLIF for low back pain. The available data appear to suggest that MIS TLIF may be associated with accelerated return to work and narcotic independence compared with open TLIF. Further analysis will be necessary to quantify the impact of MIS TLIF on workplace productivity and the indirect costs borne by patients and employers. Such information will be of value to case managers, disability managers, employers, patients, and clinicians aligned on reducing morbidity and hastening return to normal function.
authors: Vanderbilt University Medical Center, USA. scott.parker@vanderbilt.com
authors: Scott L
authors: SL
authors: Parker
authors: Jason
authors: J
authors: Lerner
authors: Matthew J
authors: MJ
authors: McGirt
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019090:Case Management; D003657:Decision Making; D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures; D016272:Occupational Health; D010149:Postoperative Pain / Q000188:drug therapy* / Q000534:rehabilitation; D011379:Prognosis; D062707:Return to Work; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods* / Q000451:nursing; D013997:Time Factors; D016896:Treatment Outcome; D014938:Work Capacity Evaluation
chemical_list: D000701:Analgesics, Opioid