Comparison of Post-operative Functional Recovery Following Awake Endoscopic Transforaminal Lumbar Interbody Fusion Versus Lumbar Laminectomy Under General Anesthesia

INTRODUCTION: Minimally invasive techniques and awake surgery have changed the nature of fusion surgery, though these effects are not yet fully characterized due to the subjective nature of patient reported outcome measures (PROMs). Physical activity data measured from smartphone accelerometers offer the ability to objectively quantify the benefits of surgical intervention and time to functional recovery. METHODS: Patients undergoing single-level open lumbar decompression and awake, endoscopic lumbar fusion under an enhanced recovery after surgery (ERAS) protocol over a 5-year period were eligible for inclusion in this retrospective multi-institution study. Included patients were required to own an Apple iPhone (Apple Inc., Cupertino, CA) and have at least eight months of continuous pre-operative smartphone accelerometer data. Pre-operative demographics and changes in peri-operative activity levels were compared between the two patient groups. RESULTS: A total of 33 patients met inclusion criteria, of which 17 underwent awake, endoscopic fusion and 16 underwent open lumbar laminectomy. Fifteen of the 17 patients (88.2%) receiving endoscopic fusion achieved functional recovery within 1 year of surgery. The average length of time to reach functional recovery was 113.8 ± 28.8 days. In comparison, 13 of 16 patients (81.3%) receiving lumbar laminectomy without fusion achieved functional recovery, requiring 105 ± 18.2 days on average. There was no statistical difference in time-to-recovery between groups (p = 0.798). CONCLUSIONS: Minimally invasive fusion surgery in the setting of awake spinal anesthesia and peri-operative ERAS protocols allow for a recovery time that is statistically equivalent to post-operative recovery periods of less anatomically invasive decompression surgeries. These findings warrant further investigation and comparison of the functional outcomes of ultra-minimally invasive surgical procedures to traditional standard of care treatments.