129 - Early Clinical Experience with Non-Expandable Slotted, Beveled 18/22mm Tube for Paraspinal Minimally Invasive Posterior Access for Lumbar Spine Decompression and Fusion Procedures

Purpose: To study early clinical experiences of minimally invasive spine surgeries (MSS) using non-expandable beveled slotted 18/22mm tubular retractor with paraspinal posterior approach.
Materials and

Methods: A retrospective review of consecutive MISS patients between 2019-2022 was performed. Inclusion criteria consisted of patients undergoing posterior decompression (PD), laminectomy with posterior fusion (PF), and single-level transforaminal lumbar interbody fusion (TLIF). Primary outcomes measures were intraoperative variables including radiation time and dose, blood loss (EBL), and OR time. Secondary measures were postoperative variables including length of stay, discharge disposition, and opioid requirements. p< 0.05 was considered significant. Surgery protocol included single paraspinal incision, non-expandable 18/22 mm beveled+ slotted tube, operating microscope, fluoroscopic guidance, EMG and SSEP spinal monitoring, and enhanced recovery after surgery (ERAS) perioperative care plan.

Results: 162 patients met inclusion criteria. Demographics and comorbidities were generally similar among all groups except for age (Table 1). Overall, increasing invasiveness of the procedure resulted in longer OR time, greater EBL, and higher radiation (Table 1). However, there were no differences in EBL between laminectomy with PF and single-level TLIF. Patients who underwent less invasive procedures required fewer opioid doses over a shorter duration (Table 2).

Discussion: Slotted, beveled 18/22 mm non-expandable tubular retractor allows for safe and adequate minimally invasive posterior access to lumbar spine for decompression and fusion procedures. The slotted design with the beveled option improves the degrees of freedom for better instrument maneuverability, surgical field visualization and dexterity. The safe and effective use of this retractor may comfort surgeons in choosing to transition from open to posterior MISS procedures. ERAS protocol has shown to minimize narcotic use and hospital length of stay. Considerations include special equipment, personnel training, surgeon experience, and patient selection.