Removal or Nonremoval of the Rib During a Direct Lateral Interbody Fusion Relative to Postoperative Pain.

Abstract

Study design: Retrospective chart review.

Objective: To determine whether there was a difference in postoperative pain among patients undergoing direct lateral interbody fusion (DLIF) who had rib removal compared with those who did not.

Background: DLIF is a minimally invasive, lateral transpsoas surgical approach for spinal fusion that has a lower 2-year pain rating when compared with an open procedure. However, the DLIF surgical approach of the L1/L2 spinal level can be obstructed by the ribs. It is unknown whether patients undergoing a DLIF with rib removal experience more pain than their counterparts without rib removal.

Methods: Patients who underwent a DLIF from an individual spine surgeon at Wesley Medical Center between January 1, 2014 and December 31, 2018 were grouped by rib status: with removal versus without. Postoperative pain, measured by a 0 (no pain) to 10 (worst pain) Visual Analog Scale (VAS), was recorded on the day of discharge.

Results: The analysis included data from 136 patients, 75 with removal and 61 without. Patient demographics did not differ significantly by age, sex, insurance, estimated blood loss, or length of stay. However, number of spinal levels fused was greater when rib removal occurred, 4.5 versus 3.5 (P = 0.008). The mean baseline VAS with rib removal was 6.6 (1.7) and at discharge it was 7.6 (2.1). The mean baseline VAS without removal was 6.7 (2.0) compared with 7.8 (1.8) at discharge. The multivariate model predicting discharge VAS indicated there was no difference in pain by rib removal status (P = 0.180). VAS at discharge was associated with positive morphine milligram equivalents; as the VAS pain score increased so did the morphine dose (P = 0.028).

Conclusion: Patients undergoing a DLIF with rib removal expressed no difference in postoperative pain compared with patients without rib removal.