What Factors Are Important to Patients When Deciding Between Minimally Invasive or Open Surgery for Posterior Lumbar Fusion?
Written by Kristin Della Volpe
Research on whether minimally invasive surgery (MIS) for lumbar spine fusion is more advantageous than open surgery has been the topic of much debate. While studies suggest less blood loss and fewer infections with MIS, this approach may take longer and be more technically demanding.
Given the lack of consensus on which approach may be best, patient education and shared decision-making can be complex. New findings suggest that patient preference may be influenced by many factors during consent-taking, as reported in the August issue of The Spine Journal.
“Our study demonstrated that patients change their decisions between MIS and open approaches frequently during the process of consent-taking,” said lead author Hwee Weng Dennis Hey, FRCSEd (Orth), FAMS (Orth), MCI, Consultant, Orthopaedic and Spine Surgery, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System in Singapore. “This is likely due to the different weight each patient gives to the advantages and disadvantages of MIS or open surgery.”
“The most common concerns influencing patients’ final decision are radiation and cosmesis,” Dr. Hey told SpineUniverse. “As a result, consent-taking should be conscientious such that patients are adequately informed. Radiation and cosmesis should be given more emphasis.”
Cross Sectional Study of Patients with Lumbar Spondylolisthesis
The findings are based on a cross-sectional study of 54 patients (mean age, 55.8 years) collected over a 3-month period at a single institution in Singapore. These patients were indicated for transforaminal lumbar interbody fusion (TLIF) for radiographically confirmed lumbar spondylolisthesis. All patients had chronic low back pain and radiculopathy. Patients who had undergone previous spine surgery, had concurrent spine pathologies (eg, tumors, infection, or fractures), or had high-grade spondylolisthesis were excluded from the study.
Standardized Consent-Taking Process
An independent spine specialist interviewed patients using a script that required patients to decide between MIS or open surgery at various points during the consent-taking process. Pictures of the scars from MIS and open surgery as well as information on the potential advantages and disadvantages of both approaches were also provided.