title: Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study.
abstract: BACKGROUND
  Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus open TLIF, addressing lumbar degenerative disc disease (DDD) or grade I spondylolisthesis (DS), are associated with shorter hospital stays, decreased blood loss, quicker return to work, and equivalent short- and long-term outcomes. However, no prospective study has assessed whether the extent of intraoperative muscle trauma utilizing creatinine phosphokinase levels (CPK) differently impacts long-term outcomes.
  
  
  METHODS
  Twenty-one patients underwent MIS-TLIF (n = 14) versus open-TLIF (n = 7) for DDD or DS. Serum CPK levels were measured at baseline, and postoperatively (days 1, 7, and 1.5, 3 and 6 months). The correlation between the extent of intraoperative muscle trauma and two-year improvement in functional disability was evaluated (multivariate regression analysis). Additionally, baseline and two-year changes in Visual Analog Scale (VAS)-leg pain (LP), VAS-back pain (BP), Oswestry Disability Index (ODI), Short-Form-36 (SF-36) Physical Component Score (PCS) and SF-36 Mental Component Score (MCS), and postoperative satisfaction with surgical care were assessed.
  
  
  RESULTS
  Although the mean change from baseline in the serum creatine phosphokinase level on POD 1 was greater for MIS-TLIF (628.07) versus open-TLF (291.42), this did not correlate with lesser two-year improvement in functional disability. Both cohorts also showed similar two-year improvement in VAS-LP, ODI, and SF-36 PCS/MCS.
  
  
  CONCLUSIONS
  Increased intraoperative muscle trauma unexpectedly observed in higher postoperative CPK levels for MIS-TLIF versus open-TLIF did not correlate with any differences in two-year improvement in pain and functional disability.
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Kwame
authors.initials: K
authors.lastname: Johnson
authors.forename: Elliot T
authors.initials: ET
authors.lastname: Min
authors.forename: Neil
authors.initials: N
authors.lastname: Issar
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Carr
authors.forename: Kevin
authors.initials: K
authors.lastname: Huang
authors.forename: Joseph
authors.initials: J
authors.lastname: Cheng