Long-Term Outcomes of Minimally Invasive vs. Traditional Open Spinal Fusion: A Comparative Analysis.

Journal of spine research and surgery Pub Date : 2025-01-01 Epub Date: 2025-03-26
Bahram Saber, Devendra K Agrawal
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Abstract

Spinal fusion is a widely performed surgical intervention for managing degenerative spinal conditions, instability, and deformities. Traditionally, open spinal fusion has been the standard approach, offering direct visualization and access to spinal structures. However, advancements in surgical techniques have led to the development of minimally invasive spinal fusion (MISF) as an alternative, aiming to achieve comparable clinical outcomes while reducing surgical trauma, postoperative pain, and recovery time. Despite these advantages, concerns remain regarding the long-term effectiveness of MISF, particularly in terms of fusion rates, complication risks, and adjacent segment disease (ASD). This review critically examines the long-term outcomes of MISF compared to traditional open fusion, focusing on key factors such as perioperative outcomes, pain relief, functional recovery, fusion success rates, and cost-effectiveness. Perioperative data indicate that MISF is associated with reduced blood loss, shorter hospital stays, and lower infection rates but may involve longer surgical times and a steeper learning curve. Long-term clinical outcomes appear comparable between MISF and open fusion, with both techniques achieving high fusion rates and significant improvements in pain and function. However, the impact of MISF on adjacent segment disease remains inconclusive, with conflicting evidence regarding its potential biomechanical advantages. Cost-effectiveness analyses suggest that MISF may offer financial advantages in the long term by reducing hospitalization and rehabilitation expenses, despite higher initial surgical costs. Nonetheless, limitations in current research, including variability in study methodologies, patient selection, and surgeon expertise, necessitate further high-quality, long-term randomized controlled trials. This review synthesizes the current literature on MISF and traditional open fusion, identifies existing research gaps, and outlines future directions for optimizing surgical decision-making and improving patient outcomes.

微创与传统开放脊柱融合术的远期疗效比较分析
脊柱融合术是一种广泛应用于治疗退行性脊柱疾病、不稳定和畸形的手术干预。传统上,开放脊柱融合术一直是标准的方法,提供直接的可视化和进入脊柱结构。然而,外科技术的进步导致微创脊柱融合术(MISF)作为一种替代方法的发展,旨在达到类似的临床结果,同时减少手术创伤、术后疼痛和恢复时间。尽管有这些优势,但MISF的长期有效性仍然值得关注,特别是在融合率、并发症风险和邻近节段疾病(ASD)方面。这篇综述比较了MISF与传统开放融合的长期结果,重点关注围手术期结果、疼痛缓解、功能恢复、融合成功率和成本效益等关键因素。围手术期数据表明,MISF与出血量减少、住院时间缩短和感染率降低有关,但可能涉及更长的手术时间和更陡峭的学习曲线。MISF和开放融合的长期临床结果似乎相当,两种技术都实现了高融合率,并显著改善了疼痛和功能。然而,MISF对邻近节段疾病的影响仍然不确定,关于其潜在的生物力学优势的证据相互矛盾。成本效益分析表明,尽管初始手术费用较高,但从长期来看,MISF可通过减少住院和康复费用提供经济优势。然而,当前研究的局限性,包括研究方法、患者选择和外科医生专业知识的可变性,需要进一步的高质量、长期随机对照试验。本综述综合了目前关于MISF和传统开放融合的文献,确定了现有的研究空白,并概述了优化手术决策和改善患者预后的未来方向。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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