Single-Level Instrumented Lumbar Interbody Fusion: The Impact of Ambulatory Surgical Centers on Evidence-Based Medicine

Presented at SMISS Annual Forum 2018
By Dwight Tyndall MD
With J. Soriano-Sánchez , S. Soriano-Solis , M. Soto-Garcia , P. Trejo-Huerta ,

Disclosures: Dwight Tyndall MD F; Spineology. J. Soriano-Sánchez None, S. Soriano-Solis None, M. Soto-Garcia None, P. Trejo-Huerta None,

Introduction:

Evidence-based medicine is the emerging trend in health care reform focused on making health care safer, less complicated and more cost-effective.

Aims/Objectives:

The aim of this study is to demonstrate that a single-level instrumented posterior lumbar interbody fusion (PLIF) using a minimally invasive technique in selected patients is a safe and effective surgical procedure for the ambulatory surgery environment.

Methods:

An IRB-approved, retrospective chart review as conducted on consecutive patients treated at a single ambulatory surgical center (ASC) for single-level lumbar degenerative disc disease with an interbody fusion and posterior pedicle screw fixation.

Results:

There were seventeen patients treated at our ASC with a single-level PLIF between February, 2015 and April, 2017. This group consisted of nine females and eight males; average age was 41 years old (range 24-52), and average BMI was 30.6 (range 22.6 - 42). Five patients were smokers, and nine patients reported occasional alcohol use. Eight patients had private insurance and nine patients had Workers’ Compensation. Co-morbidities present in this group included cardiovascular disease (n=1), hypercholesterolemia (n=3), asthma (n=3), and rheumatoid arthritis (n=1). The primary diagnosis was degenerative disc disease for eight patients, recurrent herniated disc for five patients, and spondylolisthesis for four patients. The spine levels treated were L4-5 (n=7) and L5- S1 (n=10). The implant construct for all patients included polyetheretherketone (PEEK) interbody spacers and corticocancellous pedicular fixation system implants. There was one intra-operative complication in which the patient suffered a small dural tear prior to implantation of the interbody device and pedicle screws. The durotomy was too small to require sutures, but as a precaution, the patient stayed at the ASC overnight. All other patients were ambulatory and discharged on the same day they were admitted. There were no other post-operative complications. All patients received Physical and Occupational Therapy instructions prior to discharge and the smokers received cessation advice and handouts.

Conclusions:

While greater study is required, this study cohort demonstrated that with appropriate technique, single-level lumbar fusion in selected patients is a safe and effective surgical procedure for the ambulatory surgery environment. Surgical techniques such as this one offer potentially significant advantages including reduced anesthesia/ surgery time, reduced blood loss, faster recovery time, and equivalent clinical outcomes to other fusion technique.