Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Spine (Phila Pa 1976). 2012 Oct 15;37(22):1914-9. doi: 10.1097/BRS.0b013e318257d490.
A nonrandomized, nonblinded prospective review.
To analyze intraoperative, immediate postoperative, and financial outcomes in worker's compensation (WC) and non-WC patients undergoing either an open or a minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF).
Few studies have analyzed outcomes in a WC population of MIS TLIFs.
A total of 66 consecutive patients undergoing a single-level TLIF (open/MIS) were analyzed (33 open and 33 MIS). Twenty-four total WC patients were identified (11 MIS and 13 open). Patients in either cohort (MIS/open) were matched according to insurance status (WC) and medical comorbidities (Charleston disability index). Every patient in this study had a diagnosis of either degenerative disc disease or spondylolisthesis and stenosis. Operative time (min), length of stay (d), estimated blood loss (mL), anesthesia time (min), visual analogue scale scores, and hospital cost/payment amount were assessed (MIS/open and work-comp versus non-work comp).
There were no statistically significant differences between MIS WC and non-WC TLIFs with respect to surgical time, length of stay, estimated blood loss, visual analogue scale scores, and anesthesia time. There were no statistically significant differences between open WC and non-WC TLIF patients in all of the same above-mentioned parameters. There were significant differences between MIS (WC and non-WC) and open (WC and non-WC) TLIFs in clinical outcomes. There were statistically significant differences in total costs amounts between WC MIS TLIF and WC open TLIF ($28,060 vs. $33,862, respectively; P = 0.0311) and non-WC MIS TLIF versus non-WC open TLIF groups ($29,429 vs. $32,998, respectively; P = 0.0001).
Contrary to popular belief, immediate outcomes and hospitalizations between non-WC and WC populations did not differ regardless of surgical technique (MIS/open). Differences occurred in improved outcomes with an MIS TLIF versus an open TLIF even in a WC environment. MIS TLIF WC and non-WC patient hospital costs were lower than their open TLIF counterparts.
非随机、非盲前瞻性回顾。
分析在接受开放或微创经椎间孔腰椎体间融合术（TLIF）的工人赔偿（WC）和非 WC 患者中，术中、术后即刻和财务结果。
很少有研究分析 WC 人群微创 TLIF 的结果。
分析了 66 例接受单节段 TLIF（开放/微创）的连续患者（33 例开放和 33 例微创）。共确定了 24 例 WC 患者（11 例微创和 13 例开放）。无论在哪个队列（微创/开放）中，患者都根据保险状况（WC）和合并症（Charleston 残疾指数）进行匹配。本研究中的每位患者均诊断为退行性椎间盘疾病或脊椎滑脱伴狭窄。评估手术时间（分钟）、住院时间（天）、估计失血量（毫升）、麻醉时间（分钟）、视觉模拟评分和医院费用/支付金额（微创/开放和 WC 与非 WC）。
微创 WC 和非 WC TLIF 患者在手术时间、住院时间、估计失血量、视觉模拟评分和麻醉时间方面无统计学差异。开放 WC 和非 WC TLIF 患者在所有上述参数方面均无统计学差异。微创（WC 和非 WC）和开放（WC 和非 WC）TLIF 患者在临床结果方面存在显著差异。WC 微创 TLIF 和 WC 开放 TLIF 之间（分别为 28060 美元和 33862 美元；P = 0.0311）以及非 WC 微创 TLIF 和非 WC 开放 TLIF 组之间（分别为 29429 美元和 32998 美元；P = 0.0001）在总费用金额方面存在统计学差异。
与普遍看法相反，无论手术技术（微创/开放）如何，非 WC 和 WC 人群的即刻结果和住院时间均无差异。即使在 WC 环境中，微创 TLIF 与开放 TLIF 相比，结果也有改善。微创 TLIF WC 和非 WC 患者的住院费用低于其开放 TLIF 对应者。
