Spine (Phila Pa 1976) 2017 May;42(10):E567-E574
*Herbert Wertheim College of Medicine at Florida International University and Charles E. Schmidt College of Medicine at Florida Atlantic University, Fort Lauderdale, FL †Less Exposure Surgical Specialists Institute (LESS Institute), Fort Lauderdale, FL ‡Less Exposure Surgery (LES) Society, Fort Lauderdale, FL §Department of Neurosurgery, Cornwall Regional Hospital, Montego Bay, Jamaica.
Study Design: A single-center, retrospective study.
Objective: The aim of this study was to determine the safety and outcomes of total disc replacement (TDR) as an outpatient procedure in the ambulatory surgery center (ASC).
Summary Of Background Data: Anterior cervical discectomy and fusion (ACDF) has been demonstrated to be safe in the outpatient setting, as the awareness of same-day surgery procedures is on the rise due to better outcome and shorter recovery time. There is a need for motion preservation in a subset of patients TDR provides a solution. Transitioning spine surgery to the outpatient setting including cervical TDR is the next logical step.
Methods: The medical records of 55 consecutive patients undergoing single level TDR (Group 1) were compared with our control group of 55 patients who had single-level ACDF (Group 2). Outcomes assessed included Visual Analogue Scale (VAS) neck, arm, neck disability index (NDI) scores, and complication rate.
Results: Fifty-five patients in Group 1 (TDR, 60%) were male with the group's mean age being 42.6 ± 1.4 years and body mass index (BMI) 24.8 ± 1.2 kg/m. Fifty-five patients in Group 2 (ACDF), 57%, were male with the group's mean age being 53 ± 1.0 years and mean BMI 27.9 ± 0.8 kg/m. There was no statistically significant intergroup difference in 2-year VAS neck, arm and NDI scores. Dysphagia was the most common postoperative compliant in both groups (six patients), with no intergroup significance, P = 0.4.
Conclusion: In the ambulatory setting, TDR has shown statistical significant intragroup improvement in VAS neck, arm pain scores, and NDI scores (P < 0.001). In this study, no patients reported serious complications, no incidence of hematoma formation, or worsening postop pain. We conclude that single-level TDR can be safely done in an ASC with satisfactory clinical and patient-reported outcomes. This is comparable to single-level ACDF in the outpatient setting and previous 2-year TDR studies.
Level Of Evidence: 3.