title: Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review.
abstract: OBJECTIVE
  To compare minimally invasive (MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion (TLIF) surgeries with respect to length of surgery, estimated blood loss (EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay (LOS).
  
  
  METHODS
  A systematic review of previously published studies accessible through PubMed was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.
  
  
  RESULTS
  A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery (177.5 min vs 129.0 min, P = 0.04), shorter LOS (4.3 d vs 5.3 d, P = 0.01) and less perioperative pain (visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients (postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL (352 mL vs 580 mL, P < 0.0001) and LOS (7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.
  
  
  CONCLUSIONS
  Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find non-inferior perioperative outcomes at this time.
authors.affiliation: Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Branko
authors.initials: B
authors.lastname: Skovrlj
authors.affiliation: Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: Belton
authors.affiliation: Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Hekmat
authors.initials: H
authors.lastname: Zarzour
authors.affiliation: Branko Skovrlj, Hekmat Zarzour, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States.
authors.forename: Sheeraz A
authors.initials: SA
authors.lastname: Qureshi
keywords: Estimated blood loss; Length of stay; Length of surgery; Lumbar spine; Minimally invasive; Narcotic use; Neurologic complications; Perioperative outcomes; Postoperative pain; Spine surgery; Transfusion