title: MASTERS-D Study: A Prospective, Multicenter, Pragmatic, Observational, Data-Monitored Trial of Minimally Invasive Fusion to Treat Degenerative Lumbar Disorders, One-Year Follow-Up.
abstract: The objective of the study is to assess effectiveness and safety of minimally invasive lumbar interbody fusion (MILIF) for degenerative lumbar disorders (DLD) in daily surgical practice and follow up with patients for one year after surgery. A prospective, multicenter, pragmatic, monitored, international outcome study in patients with DLD causing back/leg pain was conducted (19 centers). Two hundred fifty-two patients received standard of care available in the centers. Patients were included if they were aged >18 years, required one- or two-level lumbar fusion for DLD, and met the criteria for approved device indications. Primary endpoints: time to first ambulation (TFA) and time to surgery recovery (TSR). Secondary endpoints: patient-reported outcomes (PROs)--back and leg pain (visual analog scale), disability (Oswestry Disability Index (ODI)), health status (EQ-5D), fusion rates, reoperation rates, change in pain medication, rehabilitation, return to work, patient satisfaction, and adverse events (AEs). Experienced surgeons (≥30 surgeries pre-study) treated patients with DLD by one- or two-level MILIF and patients were evaluated for one year (NCT01143324). At one year, 92% (233/252) of patients remained in the study.
  
  
  METHODS
  TFA, 1.3 ±0.5 days and TSR, 3.2 ±2.0 days.
  
  
  RESULTS
  Most patients (83.3%) received one level MILIF; one (two-level) MILIF mean surgery duration, 128 (182) min; fluoroscopy time, 115 (154) sec; blood loss, 164 (233) mL; at one year statistically significant (P<.0001) and clinically meaningful changes from baseline were reported in all PROs--reduced back pain (2.9 ±2.5 vs. 6.2 ±2.3 at intake), reduced leg pain (2.2 ±2.6 vs. 5.9 ±2.8), and ODI (22.4% ± 18.6 vs. 45.3% ± 15.3), as well as health-related quality of life (EQ-5D index: 0.71 ±0.28 vs. 0.34 ±0.32). More of the professional workers were working at one year than those prior to surgery (70.3% vs. 55.2%). Three AEs and one serious AE were considered procedure-related; there were no deep site infections or deaths. This is the first study evaluating MILIF for treatment of DLD in daily clinical practice. Clinically significant improvements were observed in all endpoints. Short-term post-surgery improvements (four weeks) were maintained through one year with minimal complications. Our results suggest that MILIF has good-to-excellent outcomes for the treatment of DLD in a broad patient population under different clinical conditions and healthcare delivery systems.
authors.affiliation: Klinikum Dortmund.
authors.forename: Jörg
authors.initials: J
authors.lastname: Franke
authors.affiliation: Horizon Health Network.
authors.forename: Neil
authors.initials: N
authors.lastname: Manson
authors.affiliation: Karvinska hornicka nemocnice.
authors.forename: David
authors.initials: D
authors.lastname: Buzek
authors.affiliation: Orthopedics, Klinikum Kulmbach.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Kosmala
authors.affiliation: Faculty of Medicine, University of Freiburg, Germany, Neurosurgical Clinic, Medical Center, University of Freiburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
authors.affiliation: Orthopedics, Franciscus Ziekenhuis, Rosendaal.
authors.forename: Wout
authors.initials: W
authors.lastname: Rosenberg
authors.affiliation: Faculty of Medicine of the University of Porto ; Centro Hospitalar São João.
authors.forename: Paulo
authors.initials: P
authors.lastname: Pereira
authors.affiliation: Neurosurgery, Fatebenefratelli Hospital.
authors.forename: Roberto
authors.initials: R
authors.lastname: Assietti
authors.affiliation: Orthopedics, Ons Lieve Vrouw Ziekenhuis.
authors.forename: Frederic
authors.initials: F
authors.lastname: Martens
authors.affiliation: Spine surgery, London Bridge Hospital, London, UK.
authors.forename: Khai
authors.initials: K
authors.lastname: Lam
authors.affiliation: Istituto Ortopedico Rizzoli, Bologna, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barbanti Brodano
authors.affiliation: Neurosurgery, Ustredna vojenska nemocnica SNP, Ruzomberok, Slovakia.
authors.forename: Peter
authors.initials: P
authors.lastname: Durny
authors.affiliation: Neurosurgery, The Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Zvi
authors.initials: Z
authors.lastname: Lidar
authors.affiliation: Neurosurgery, Klinikum Dortmund.
authors.forename: Kai
authors.initials: K
authors.lastname: Scheufler
authors.affiliation: Klinikum Amstetten.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Senker
keywords: degenerative lumbar disorders; minimal access spinal technologies; minimally invasive lumbar fusion; patient-reported outcomes; pragmatic