Comparison of the results of MIS-TLIF and open TLIF
               techniques in laborers

Oliveira, Daniel De Abreu; Rosa, Márcio Guglielmi; Machado, Wilson De Jesus; Falcon, Roberto Sakamoto

doi:10.1590/S1808-18512014130200337

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Original Articles • Coluna/Columna 13 (02) • 2014 • https://doi.org/10.1590/S1808-18512014130200337 copy

Comparison of the results of MIS-TLIF and open TLIF techniques in laborers

Comparação dos resultados do MIS-TLIF versus TLIF aberto em trabalhadores braçais

Comparación de los resultados de las técnicas MIS-TLIF y TLIF abierta en obreros

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To compare clinical outcomes in laborers who have undergone open transforaminal interbody fusion (TLIF) and minimally invasive transforaminal interbody fusion (MIS TLIF). Methods: 78 patients were submitted to lumbar arthrodesis by the same two spine surgeons partners from January 2008 to December 2012. Forty-one were submitted to traditional open arthrodesis and 37 to the minimally invasive procedure. Three patients were not included because they had already retired from work. The analyzed variables were length of hospitalization, length of follow-up, type of access (TILF or MIS TLIF), need for blood transfusion, percentage of improvement or worsening after surgery, pre- and postoperative VAS scale, time off work, pre-and postoperative Oswestry disability index, and general aspects of the laborers such as age, education, profession, working time, amount of daily weight carried at work, and use or not of personal protective equipment. Results: Time off work was longer in the TLIF group (average of 9.84 months) compared with the MIS TLIF group (average of 3.20 months). Significant improvement in postoperative VAS and Oswestry was achieved in both groups. Average length of hospitalization was 5.73 days for the TLIF group and 2.76 days for the MIS TLIF group. Conclusions: Minimally invasive transforaminal lumbar interbody fusion presents similar results when compared to open TLIF, but has the benefits of less postoperative morbidity, shorter hospitalization times, and faster rehabilitation in laborer patients.

Arthrodesis; Lumbar vertebrae; Spinal fusion; Minimally invasive surgical procedures; Occupational health

Variable	Type of surgery	N	Mean	E.P.	1 Q	2 Q	3 Q	P-value
Age (years)	OS	41.00	48.29	1.66	42.00	47.00	54.00	0.018
Age (years)	MIS	37.00	42.27	1.94	33.00	43.00	49.00	0.018
Hospitalization time (days)	OS	41.00	5.73	0.82	3.00	5.00	7.00	< 0.001
Hospitalization time (days)	MIS	37.00	2.76	0.23	2.00	3.00	4.00	< 0.001
Follow-up time (months)	OS	41.00	24.07	2.40	12.00	24.00	36.00	0.169
Follow-up time (months)	MIS	37.00	19.08	1.68	12.00	18.00	24.00	0.169
Service time (years)	OS	41.00	16.22	1.83	7.00	15.00	22.00	1.000
Service time (years)	MIS	37.00	15.35	1.45	8.00	15.00	20.00	1.000
Improvement index	OS	41.00	0.66	0.07	0.60	0.80	0.90	0.001
Improvement index	MIS	37.00	0.88	0.02	0.80	0.90	1.00	0.001
Pre-VAS score	OS	41.00	9.50	0.11	9.00	10.00	10.00	0.078
Pre-VAS score	MIS	37.00	9.76	0.09	10.00	10.00	10.00	0.078
Post-VAS score	OS	41.00	3.31	0.38	2.00	3.00	4.00	0.173
Post-VAS score	MIS	37.00	2.54	0.35	0.50	2.00	5.00	0.173
Time to return to work (days)	OS	41.00	9.84	1.19	4.00	7.00	12.00	< 0.001
Time to return to work (days)	MIS	37.00	3.20	0.46	1.50	2.50	4.00	< 0.001
Pre-Oswestry score	OS	41.00	40.15	3.95	24.00	32.00	64.00	< 0.001
Pre-Oswestry score	MIS	37.00	61.08	2.44	52.00	66.00	72.00	< 0.001
Post-Oswestry score	OS	41.00	18.44	3.25	4.00	10.00	20.00	0.149
Post-Oswestry score	MIS	37.00	12.65	2.36	0.00	6.00	22.00	0.149

Variables	Factors	Type of surgery						P-value	O.R.	L.I.	L.S.
Variables	Factors	OS		MIS		Total		P-value	O.R.	L.I.	L.S.
Blood transfusion	Not	23	60.5%	37	100.0%	60	80.0%	< 0.001*	1.000
	Yes	15	39.5%	0	0.0%	15	20.0%	< 0.001*	0.019	0.005	0.325
	Total	38	100.0%	37	100.0%	75	100.0%
Level of education	Elementary school	19	76.0%	6	24.0%	25	100.0%	0.009*	1.000
	Secondary school	18	46.2%	21	53.8%	39	100.0%		3.694	1.214	11.244
	Higher education	4	28.6%	10	71.4%	14	100.0%		7.917	1.804	34.737
	Total	41	52.6%	37	47.4%	78	100.0%
Weight lifted per day	More than 50 kg	30	73.2%	25	67.6%	55	70.5%	0.588	1.000
	Less than 50 kg	11	26.8%	12	32.4%	23	29.5%	0.588	1.309	0.494	3.471
	Total	41	100.0%	37	100.0%	78	100.0%
Use of protective equipment	No	23	56.1%	11	29.7%	34	43.6%	0.019	1.000
	Yes	18	43.9%	26	70.3%	44	56.4%	0.019	3.020	1.184	7.706
	Total	41	100.0%	37	100.0%	78	100.0%
Sex	Female	13	31.7%	12	32.4%	25	32.1%	0.945	1.000
	Male	28	68.3%	25	67.6%	53	67.9%	0.945	0.967	0.373	2.506
	Total	41	100.0%	37	100.0%	78	100.0%

Variable	N	Mean	E.P.	1 Q	2 Q	3 Q	P-value
VAS score of the difference (Post - Pre)	78.00	-6.68	0.28	-8.00	-7.00	-5.00	< 0.001
Oswestry score of the difference (Post - Pre)	78.00	-34.39	2.81	-52.00	-30.00	-14.00	< 0.001

Variable	Type of surgery	N	Mean	E.P.	1 Q	2 Q	3 Q	P-value
VAS score of the difference (Post - Pre)	OS	41.00	-6.20	0.40	-8.00	-7.00	-5.00	< 0.001
VAS score of the difference (Post - Pre)	MIS	37.00	-7.22	0.38	-9.00	-7.00	-5.00	< 0.001
Oswestry score of the difference (Post - Pre)	OS	41.00	-21.71	3.48	-32.00	-14.00	-10.00	< 0.001
Oswestry score of the difference (Post - Pre)	MIS	37.00	-48.43	3.22	-66.00	-52.00	-30.00	< 0.001

Variables	Type of surgery	Follow-up time
Variables	Type of surgery	R	P-value
Pre-Oswestry score	OS	-0.125	0.437
Pre-Oswestry score	MIS	-0.072	0.671
Post-Oswestry score	OS	0.048	0.764
Post-Oswestry score	MIS	-0.488	0.002

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[1] Correspondence: NOT - Núcleo de Ortopedia e Traumatologia. Rua Aimorés, 2125 Lourdes. Belo Horizonte, MG, Brazil. 30140-072. danielcoluna@me.com