Parker Scott L, Lerner Jason, McGirt Matthew J
Vanderbilt University Medical Center, USA.
Prof Case Manag. 2012 Sep-Oct;17(5):229-35. doi: 10.1097/NCM.0b013e3182529c05.
Low back pain is one of the most prevalent and disabling musculoskeletal conditions affecting the working population in the United States. Informed, shared decision making among patients, clinicians, and case managers about treatment options for chronic low back pain-including the role of spinal fusion where medically necessary-can have a meaningful impact on return to work, normal function, and economic outcomes. Minimally invasive techniques for lumbar spinal fusion, including transforaminal lumbar interbody fusion (MIS TLIF) have recently been introduced with the goal of smaller operative wounds, less tissue trauma, and faster postoperative recovery when compared with open fusion. Although similar long-term clinical outcomes have been reported for MIS TLIF and open TLIF, the relative merits with respect to workplace productivity have not been comprehensively investigated. Time to return to work and narcotic independence after MIS TLIF and open TLIF are important parameters that may affect overall workplace productivity, and as such are the focus of this study.
PRIMARY PRACTICE SETTING(S): This study was performed via a review of the literature.
We performed a systematic literature review to identify all published articles that reported on the postoperative outcomes of patients, as assessed by return to work or narcotic independence status or both, following MIS TLIF or open TLIF. A cumulative comparison was made for all included MIS TLIF versus open TLIF surgeries.
Seventy-four published studies reported postoperative outcomes following MIS TLIF or open TLIF; only five (6.8%) studies directly described time to return to work or duration of narcotic use postoperatively or both, and were therefore included into the analysis of this review. Four studies in the published literature describe time to return to work following MIS TLIF or open TLIF, and two studies describe time to narcotic independence. Overall, the reviewed literature suggests that MIS TLIF may be associated with an accelerated time to narcotic independence and return to work versus open TLIF.
There are limited data regarding time to return to work and duration of postoperative narcotic use following TLIF for low back pain. The available data appear to suggest that MIS TLIF may be associated with accelerated return to work and narcotic independence compared with open TLIF. Further analysis will be necessary to quantify the impact of MIS TLIF on workplace productivity and the indirect costs borne by patients and employers. Such information will be of value to case managers, disability managers, employers, patients, and clinicians aligned on reducing morbidity and hastening return to normal function.
腰痛是影响美国劳动人口的最常见且致残的肌肉骨骼疾病之一。患者、临床医生和病例管理人员之间就慢性腰痛的治疗方案进行明智的、共同的决策，包括在医学必要时脊柱融合术的作用，这对恢复工作、正常功能和经济结果可能会产生重大影响。腰椎融合的微创技术，包括经椎间孔腰椎椎体间融合术（MIS TLIF），最近已被引入，其目标是与开放融合相比，手术伤口更小、组织创伤更少且术后恢复更快。尽管已有报道称MIS TLIF和开放TLIF的长期临床结果相似，但关于工作场所生产力方面的相对优点尚未得到全面研究。MIS TLIF和开放TLIF术后恢复工作的时间以及停用麻醉剂的时间是可能影响整体工作场所生产力的重要参数，因此也是本研究的重点。
本研究通过文献综述进行。
我们进行了一项系统的文献综述，以确定所有已发表的文章，这些文章报告了患者在接受MIS TLIF或开放TLIF术后的结果，通过恢复工作或停用麻醉剂状态或两者来评估。对所有纳入的MIS TLIF与开放TLIF手术进行了累积比较。
74项已发表的研究报告了MIS TLIF或开放TLIF术后的结果；只有5项（6.8%）研究直接描述了术后恢复工作的时间或麻醉剂使用时长或两者，因此被纳入本综述的分析。已发表文献中的4项研究描述了MIS TLIF或开放TLIF术后恢复工作的时间，2项研究描述了停用麻醉剂的时间。总体而言，综述文献表明，与开放TLIF相比，MIS TLIF可能与停用麻醉剂和恢复工作的时间加快有关。
关于腰痛患者TLIF术后恢复工作的时间和术后麻醉剂使用时长的数据有限。现有数据似乎表明，与开放TLIF相比，MIS TLIF可能与恢复工作和停用麻醉剂的时间加快有关。需要进一步分析以量化MIS TLIF对工作场所生产力的影响以及患者和雇主承担的间接成本。这些信息对于致力于降低发病率和加速恢复正常功能的病例管理人员、残疾管理人员、雇主、患者和临床医生将具有价值。
