title: Minimally Invasive Versus Open Lumbar Fusion: A Comparison of Blood Loss, Surgical Complications, and Hospital Course.
abstract: BACKGROUND
  Perioperative blood loss is a frequent concern in spine surgery and often necessitates the use of allogeneic transfusion. Minimally invasive technique (MIS) is an option that minimizes surgical trauma and therefore intra-operative bleeding. The purpose of this study is to evaluate the blood loss, surgical complications, and duration of inpatient hospitalization in patients undergoing open posterolateral lumbar fusion (PLF), open posterior lumbar interbody fusion (PLIF) with PLF, or MIS transforaminal lumbar interbody fusion (MIS TLIF).
  
  
  METHODS
  Operative reports and perioperative data of patients undergoing single-level, primary open PLF (n=41), open PLIF/PLF (n=42), and MIS TLIF (n=71) were retrospectively evaluated. Patient demographics, operative blood loss, use of transfusion products, complications, and length of stay were tabulated. Patient data was controlled for age, BMI, and gender for statistical analysis.
  
  
  RESULTS
  Patients undergoing open PLF and open PLIF/PLF respectively experienced a significantly higher blood loss (p<0.001), higher volume of blood transfusion (p<0.001), higher volume of cell saver transfusion (p<0.001), and more surgical complications (dural injury, wound infections, screw malposition) (p=0.02) than those undergoing MIS TLIF. There was no statistically significant difference in duration of hospital stay (p=0.11).
  
  
  CONCLUSIONS
  MIS TLIF provides interbody fusion with less intraoperative blood loss and subsequently a lower transfusion rate compared to open techniques, but this did not influence length of hospital stay. MIS TLIF is at least as safe as open techniques with respect to dural tear, wound infection, and screw placement.
  
  
  METHODS
  Level III, Therapeutic.
authors.affiliation: University of Miami, Miller School of Medicine Department of Orthopaedics Miami , FL.
authors.forename: Amar A
authors.initials: AA
authors.lastname: Patel
authors.affiliation: Lenox Hill Hospital Department of Orthopaedics New York , New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Zfass-Mendez
authors.affiliation: University of Miami, Miller School of Medicine Department of Orthopaedics Miami , FL.
authors.forename: Nathan H
authors.initials: NH
authors.lastname: Lebwohl
authors.affiliation: University of Miami, Miller School of Medicine Department of Neurological Surgery Miami , FL.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
authors.affiliation: University of Miami, Miller School of Medicine Department of Neurological Surgery Miami , FL.
authors.forename: Barth A
authors.initials: BA
authors.lastname: Green
authors.affiliation: University of Miami, Miller School of Medicine Department of Neurological Surgery Miami , FL.
authors.forename: Allan D
authors.initials: AD
authors.lastname: Levi
authors.affiliation: University of Miami, Miller School of Medicine Department of Neurological Surgery Miami , FL.
authors.forename: Steven
authors.initials: S
authors.lastname: Vanni
authors.affiliation: University of Wisconsin School of Medicine and Public Health Department of Orthopedics and Rehabilitation Madison , WI.
authors.forename: Seth K
authors.initials: SK
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000503:physiopathology; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D065227:Transfusion Reaction; D016896:Treatment Outcome