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