Comparing Minimally Invasive Transforaminal Lumbar Interbody Fusion and Open TLIF: Impact on Patient Satisfaction and Surgical Outcomes

Introduction: Transforaminal lumbar interbody fusion (TLIF) treats spinal instability, radiculopathy, and degenerative disc disease. Classically performed utilizing an open approach, minimally invasive (MIS) TLIF techniques now offer key advantages. While the surgical benefits are well-studied, the impact of MIS TLIF on patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is less explored. This study examines whether MIS TLIF improves patient satisfaction compared to Open TLIF.

Methods: A review of electronic medical records for TLIF procedures at the large tertiary care center between 04/2016 and 12/2023 collected demographic, surgical data, and patient satisfaction using postoperative HCAPHS scores. Outcomes were analyzed using Student's t-test, chi-square test, and multivariable logistic analysis, with a p-value < 0.05 considered significant.

Results: Twenty MIS TLIF and 174 Open TLIF procedures were analyzed. There were no significant demographic differences between the groups in terms of age, sex, BMI, smoking history, follow-up time, race, or ethnicity. Both cohorts had similar average operative times (217 minutes) and length of stay (4 days). MIS TLIF involved one level of decompression, while Open TLIF involved two or more. There was a significant difference in facetectomy type between surgical approaches (p = < 0.001). The HCAPHS data for both surgical approaches displayed similar outcomes regarding the questions “Doctor Respectful”, “Doctor Listens”, “Doctor Explains”, “Recommend Hospital”, “Overall Health”, and “Mental Health”. There were statistically significant differences seen with complications with respect to different level of reoperation within one year, 90-day readmission, and 90-day ED visit (p = < 0.001) between cohorts, but there were no statistically significant differences seen with respect to postoperative infection, instrument failure, deep vein thrombosis within three months, or revision surgery. Patients with increased BMI were less likely to recommend the hospital in their HCAPHS survey (OR: 0.928; 95% CI: 0.859-0.998; p = 0.048).

Conclusion : This study demonstrates that MIS and Open TLIF have similar HCAPHS outcomes. Based on these findings, surgeons should utilize the surgical approach they are most comfortable with to achieve the best outcomes for patients. Additionally, the findings of the study will be relevant to help guide improved patient selection, outcomes, and satisfaction.