Spinal fusion surgery, a critical intervention for treating a variety of spinal disorders, including degenerative disc disease, spinal instability, and deformities, has evolved significantly with advancements in surgical techniques. Traditionally, open spinal fusion has been the standard approach, involving extensive tissue dissection to access the spine. However, this method is often associated with significant postoperative pain, longer hospital stays, and extended recovery periods.[1][2]

In recent years, minimally invasive spinal fusion techniques have been developed to reduce operative trauma, minimize postoperative pain, and accelerate patient recovery. These techniques utilize smaller incisions, cause less muscular disruption, and reduce intraoperative blood loss compared to traditional open surgery. The purported advantages of minimally invasive surgery (MIS) include better cosmetic outcomes, reduced infection rates, and quicker functional recovery, potentially leading to a shorter hospitalization duration and faster return to daily activities.[3][4]

Despite these benefits, the comparative effectiveness of minimally invasive versus traditional open spinal fusion techniques on postoperative recovery remains a subject of ongoing research. Variations in patient outcomes such as pain levels, functional recovery, complication rates, and long-term spinal health are critically important factors in determining the best surgical approach.

The objective of this study is to conduct a comprehensive comparison of these two surgical modalities to provide evidence-based guidance for spinal surgeons and healthcare professionals.[5][6]

Aim

To compare the postoperative recovery outcomes between minimally invasive and traditional open spinal fusion techniques.

 Objectives

1. To evaluate the difference in postoperative pain levels between minimally invasive and traditional open spinal fusion methods.
2. To assess the duration of hospital stay and time to return to normal activities post-surgery for both techniques.
3. To analyze the complication rates and long-term functional outcomes associated with each surgical approach.

Source of Data

Data were collected from patients undergoing spinal fusion surgery at a tertiary care hospital.

Study Design

This study utilized a retrospective cross-sectional design to assess the outcomes of spinal fusion surgeries performed using minimally invasive and traditional open techniques.

Study Location

The study was conducted at the Spine Surgery Department of Orthopedics, Tertiary care hospital.

Study Duration

Data collection spanned from January 2023 to December 2023, allowing for a comprehensive capture of postoperative outcomes.

Sample Size

A total of 140 patients were included in the study, with 70 undergoing minimally invasive spinal fusion and 70 undergoing traditional open spinal fusion.

Inclusion Criteria

Patients aged 18-65 years diagnosed with lumbar degenerative disc disease requiring spinal fusion, who consented to participate in the study.

Exclusion Criteria

Patients were excluded if they had previous spinal surgery, spinal tumor, infection, or metabolic bone disease.

Procedure and Methodology

Patients were allocated to either the minimally invasive or traditional open spinal fusion group based on their preoperative consultation. Surgical details, including approach, instrumentation, and fusion technique, were meticulously recorded.

Sample Processing

No specific sample processing was required as the study was based on clinical outcomes and patient records.

Statistical Methods

Data were analyzed using SPSS software. Quantitative variables were compared using the t-test or Mann-Whitney U test, while categorical data were analyzed using the chi-square test. A p-value of less than 0.05 was considered statistically significant.

Data Collection

Data on postoperative pain, functional recovery, complication rates, and duration of hospital stay were collected through patient interviews and medical records review during follow-up visits at 1, 3, and 6 months post-surgery.

Table 1: Postoperative Recovery Outcomes Comparison

Table 1 illustrates the differences in surgical metrics between minimally invasive and traditional open spinal fusion techniques. The length of surgery was significantly shorter for minimally invasive procedures, averaging 120 minutes compared to 145 minutes for traditional open surgery, with a statistically significant difference (p=0.02). Intraoperative blood loss was also substantially reduced in the minimally invasive group, with an average loss of 150 ml versus 300 ml in the traditional open group, showing a highly significant reduction (p=0.001). Additionally, postoperative opioid use was lower in the minimally invasive group, averaging 10 mg compared to 30 mg in the traditional open group, with a very significant p-value of 0.0001.

Table 2: Difference in Postoperative Pain Levels

Table 2 focuses on the comparison of postoperative pain levels measured at three different time points: immediately after surgery, at 6 hours, and at 24 hours. Initially, the pain score was significantly lower in the minimally invasive group (3 versus 7) with a p-value of 0.001. This trend continued at 6 hours (2 versus 6) and at 24 hours post-surgery (1 versus 4), with both time points also showing statistically significant differences favoring the minimally invasive technique, demonstrating its effectiveness in reducing postoperative pain.

Table 3: Hospital Stay and Return to Normal Activities

This table evaluates the duration of hospital stay and the time required for patients to return to normal activities. Patients undergoing minimally invasive surgery had a shorter average hospital stay of 2 days compared to 5 days for those undergoing traditional open surgery, with a significant p-value of 0.0001. Furthermore, the time to return to normal activities was also shorter for the minimally invasive group (18 days) compared to the traditional open group (30 days), indicating quicker recovery times with statistical significance.

 Table 4: Complication Rates and Long-term Functional Outcomes

Table 4 presents data on the complication rates and functional outcomes at 1 year post-surgery. The complication rate was lower in the minimally invasive group (11.4%) compared to the traditional open group (35.7%), with a significant p-value of 0.002. Similarly, the long-term functional outcomes, measured by the Oswestry Disability Index, showed better results for the minimally invasive group with 21.4% showing disability compared to 57.1% in the traditional open group, which also demonstrated a highly significant difference (p=0.0001).

Table 1: Postoperative Recovery Outcomes Comparison

This table shows that minimally invasive spinal fusion techniques significantly reduce the length of surgery, intraoperative blood loss, and postoperative opioid use compared to traditional open techniques. Previous studies corroborate these findings, highlighting that minimally invasive surgery (MIS) techniques reduce operative time, decrease blood loss, and minimize the need for postoperative pain management, likely due to less tissue disruption during surgery Skovrlj B et al.(2015)[7]. A meta-analysis by Azad AK et al.(2024)[8] supports the observation of reduced intraoperative blood loss and postoperative analgesic requirements in patients undergoing MIS compared to those undergoing open surgery.

 Table 2: Difference in Postoperative Pain Levels

The results indicate significantly lower pain scores immediately post-surgery and at subsequent intervals in the minimally invasive group compared to the open surgery group. This finding aligns with Vaishnav AS et al.(2019)[9], who found that MIS patients reported lower pain scores due to smaller incisions and less muscular trauma. The reduction in pain not only enhances patient comfort but also facilitates quicker mobilization and recovery, which is crucial for the rehabilitation process Park J et al.(2020)[10].

 Table 3: Hospital Stay and Return to Normal Activities

Patients who underwent minimally invasive procedures had shorter hospital stays and faster returns to normal activities, as evidenced by the significant statistical results. These outcomes are consistent with the broader literature, which suggests that MIS can lead to faster recovery times and shorter hospital admissions Wang MY et al.(2017)[11]. The economic implications of these findings are significant, potentially reducing healthcare costs associated with prolonged hospital stays.

 Table 4: Complication Rates and Long-term Functional Outcomes

The lower complication rates and better functional outcomes at one year observed in the MIS group are significant findings of this study. Similar results were reported by Pennington Z et al.(2018)[12], who noted reduced complication rates and improved functional outcomes in patients undergoing MIS for spinal fusion. The minimization of soft tissue damage and preservation of musculature in MIS can contribute to these improved outcomes, underscoring the benefits of the technique for long-term patient health.

The cross-sectional study aimed at comparing minimally invasive spinal fusion techniques with traditional open spinal fusion has provided insightful and significant findings regarding postoperative recovery metrics. The data derived from this study conclusively demonstrated that minimally invasive techniques offer substantial benefits over traditional open surgery across several critical postoperative recovery outcomes.

Firstly, patients undergoing minimally invasive spinal fusion experienced shorter operation times, significantly less intraoperative blood loss, and reduced postoperative opioid usage. These advantages directly contribute to enhancing patient safety, reducing potential complications, and fostering a faster recovery. Pain management, a pivotal aspect of postoperative care, was markedly improved in the minimally invasive group, as evidenced by consistently lower pain scores immediately after surgery and during the subsequent recovery period. This reduced pain intensity facilitates earlier mobilization and contributes to an overall more comfortable recovery experience.

Additionally, the study revealed that patients treated with minimally invasive techniques had shorter hospital stays and quicker returns to normal activities. These outcomes not only improve the quality of life for patients but also offer economic benefits by potentially decreasing healthcare costs associated with prolonged hospitalization.

Moreover, the reduced complication rates and superior long-term functional outcomes associated with minimally invasive spinal fusion highlight its efficacy and safety, further validating its use as a preferred surgical approach in suitable cases.

In summary, the findings from this study strongly support the utilization of minimally invasive spinal fusion techniques over traditional open methods for eligible patients requiring spinal fusion surgery. These techniques enhance postoperative recovery, minimize complications, and improve long-term outcomes, marking a significant advancement in spinal surgery practices. Future research should continue to refine these techniques and explore their application in a broader range of spinal conditions to fully harness their potential benefits.

linked to purine metabolism disruptions, potentially playing a role in disease progression.

Serum Ferritin, another inflammatory marker, is also higher, reflecting the general inflammatory state in psoriasis.

Despite the increase in these biomarkers, only ADA  and hsCRP showed significant correlations with the PASI (Psoriasis Area and Severity Index) score  and uric acid showed positive correlation with severe psoriasis and  PASI (Psoriasis Area and Severity Index) score. However there were no significant correlations between the levels of, Serum Ferritin, and the PASI (Psoriasis Area and Severity Index) score.

This suggests that while these biomarkers are elevated in psoriatic patients, only ADA and hs CRP levels directly correlate with disease severity as measured by PASI. However serum ferritin and uric acid levels may not directly correlate with disease severity as measured by PASI.

1. Cross-Sectional Design: The cross-sectional nature of the study limits the ability to establish causality between surgical technique and postoperative outcomes. This design only provides a snapshot in time, potentially overlooking the evolution of recovery and long-term complications or benefits that might become apparent in a longitudinal study.
2. Sample Size: Although the study included a reasonable total sample size of 140 patients, the equal division between the two groups might still be insufficient to capture less common complications or subtle differences in recovery. Larger sample sizes could provide more robust data and reduce the risk of type II errors.
3. Selection Bias: The study may be subject to selection bias if the assignment of patients to minimally invasive or traditional open surgery was not randomized. Factors influencing the choice of surgical method, such as the severity of the condition, patient preference, or surgeon expertise, could skew results and affect the generalizability of the findings.
4. Single-Center Study: Conducting the study in a single institution may limit the generalizability of the results to other settings due to variations in surgical skill, patient demographics, and postoperative care protocols. Multi-center studies could help confirm the findings across different clinical environments and patient populations.
5. Subjective Measures: Some outcomes, particularly pain levels and functional outcomes, rely heavily on patient self-reporting, which can introduce subjectivity and potential reporting biases. Objective measures or standardized instruments could be employed to mitigate this issue.
6. Lack of Blinding: If the patients and clinicians were aware of the type of surgery performed, this awareness could influence patient reporting of symptoms and clinician assessments of outcomes, introducing performance bias.
7. Follow-up Duration: The study might not have included a long enough follow-up period to observe late complications or long-term outcomes associated with either surgical technique. Extended follow-up would be necessary to fully understand the durability and longevity of the benefits associated with each method.
8. Variability in Surgical Techniques: Minimally invasive techniques can vary widely in their specifics, such as the extent of incision, tools used, and exact procedures followed. This variability can make it difficult to standardize what constitutes "minimally invasive" across different surgeons or institutions.

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