Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion Surgery: An Analysis of Opioids, Nonopioid Analgesics, and Perioperative Characteristics.

Abstract

Retrospective study of consecutive patients at a single institution.Objective: Examine the effect of minimally invasive surgery (MIS) versus open transforaminal lumbar interbody fusion (TLIF) surgery on long-term postoperative narcotic consumption. Examine the effect of minimally invasive versus open TLIF on short-term postoperative narcotic consumption. Differences between MIS and open TLIF, including inpatient opioid and nonopioid analgesic use, discharge opioid use, and postdischarge duration of narcotic usage were compared using appropriate statistical methods. A total of 172 patients (109 open; 63 MIS) underwent primary TLIF. There was no difference in baseline characteristics. The MIS TLIF cohort had a significantly shorter operative time (223 vs 251 min, <i>P</i> = .006) and length of stay (2.7 vs 3.7 days, <i>P</i> < .001) as well as less estimated blood loss (184 vs 648 mL, <i>P</i> < .001). MIS TLIF had significantly less total inpatient opioid usage (167 vs 255 morphine milligram equivalent [MME], <i>P</i> = .006) and inpatient oxycodone usage (71 vs 105 mg, <i>P</i> = .049). Open TLIF cases required more ongoing opiate usage at 3-month follow-up (36% open vs 21% MIS, <i>P</i> = .041). A subanalysis found that patients who underwent an open TLIF with a history of preoperative opioid use are significantly more likely to remain on opioids at 6-week follow-up (87% vs 65%, <i>P</i> = .027), 3-month follow-up (63% vs 31%, <i>P</i> = .008), and 6-month follow-up (50% vs 21%, <i>P</i> = .018) compared with MIS TLIF. Patients undergoing MIS TLIF required less inpatient opioids and had a decreased incidence of opioid dependence at 3-month follow-up. Patients with preoperative opioid use undergoing MIS TLIF are less likely to require long-term opioids.