Comparing the Incidence of Index Level Fusion Following Minimally Invasive Versus Open Lumbar Microdiscectomy

Steven J. McAnany, Samuel C. Overley, Muhammad A. Anwar, Holt S. Cutler, Javier Z. Guzman, Jun S. Kim, Robert K. Merrill, Samuel K. Cho, Andrew C. Hecht, Sheeraz A. Qureshi

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Study Design: Retrospective cohort study. Objectives: To determine the incidence of index level fusion following open or minimally invasive lumbar microdiscectomy. Methods: We conducted a retrospective review of 174 patients with a symptomatic single-level lumbar herniated nucleus pulposus who underwent microdiscectomy via a mini-open approach (MIS; 39) or through a minimally invasive dilator tube (135). Outcomes of interest included revision microdiscectomy and the ultimate need for index level fusion. Continuous variables were analyzed with independent sample t test, and χ2 analysis was used for categorical data. A multivariate regression analysis was performed to identify predictive factors for patients that required index level fusion after lumbar microdiscectomy. Results: There was no difference in patient demographics in the open and MIS groups aside from length of follow-up (60.4 vs 40.03 months, P <.0001) and body mass index (24.72 vs 27.21, P =.03). The rate of revision microdiscectomy was not statistically significant between open and MIS approaches (10.3% vs 10.4%, P =.90). The rate of patients who ultimately required index level fusion approached significance, but was not statistically different between open and MIS approaches (10.3% vs 4.4%, P =.17). Multivariate regression analysis indicated that the need for eventual index level fusion after lumbar microdiscectomy was statistically predicted in smokers and those patients who underwent revision microdiscectomy (P <.05) in both open and MIS groups. Conclusions: Our results suggest a low likelihood of patients ultimately requiring fusion following microdiscectomy with predictors including smoking status and a history of revision microdiscectomy.

Original languageEnglish
Pages (from-to)11-16
Number of pages6
JournalGlobal Spine Journal
Issue number1
StatePublished - 1 Feb 2018


  • fusion after discectomy
  • lumbar microdiscectomy
  • minimally invasive spine surgery
  • revision discectomy


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