Spine (Phila Pa 1976) 2015 Jan;40(1):E36-42
*Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine at Florida Atlantic University, Boca Raton, FL †Less Exposure Surgery Specialists Institute (LESS Institute), Fort Lauderdale, FL; and ‡Less Exposure Surgery Society (LES Society), Beverly, MA.
Study Design: Retrospective study.
Objective: To report surgical and patient-reported outcomes after outpatient lumbar fusions in an ambulatory setting.
Summary Of Background Data: There is growing interest in the potential benefits of outpatient spine surgery such as reduced costs, consistent operative team, and decreased postoperative complications during in-hospital recovery. However, there are limited studies on outcomes after outpatient lumbar fusions, to guide patient selection, treatment techniques and postoperative expectations.
Methods: Medical records of 16 consecutive patients, who underwent outpatient direct open, single-level, posterior lumbar interbody fusions, were examined by a single surgeon. Outcome measures included visual analogue scale (VAS) scores for lower back and Oswestry Disability Indices (ODIs). Mean body mass indices (BMIs), estimated blood loss, surgical times and complications, and fusion rates were evaluated.
Results: Males represented 56% of patients. Mean age was 42.81 ± 3.05 years (mean ± standard error) and mean body mass index was 28.95 ± 1.04. History of smoking and narcotics use were statistically noncontributory. Mean final follow-up was 15 (range, 5.52-34.2 mo) months. Mean postoperative scores were determined by the final follow-up VAS and ODI. L5-S1 was the most common level of the 16 levels operated on (69%). Preoperative and postoperative VAS and ODI scores for lower back were obtained for 15 patients (93.75%). Mean lower back VAS score of 8.4 ± 0.37 preoperatively reduced to 4.96 ± 0.73 postoperatively, (P = 0.001). Mean ODI improved from 52.71 ± 0.04 preoperatively, to 37.43 ± 0.06 postoperatively, (P = 0.04). One patient experienced postoperative worsened back pain with clinical and radiological signs of possible aseptic discitis. Estimated blood loss was 161 ± 32 mL and average operating time was 124.85 ± 7.10 minutes. The overall fusion rate was 87.5%.
Conclusion: Direct open posterior lumbar interbody fusions were done safely with statistically significant reduction in average pain and ODI scores. Surgical times were approximately 2 hours with minimal blood loss, allowing patients to be comfortably discharged the same day without a drain.