In patients with moderate to severe pain and disability,* 83 percent of patients report returning to work in three months after Laser Spine Institute surgery.
Introduction: The safety and efficacy of outpatient minimally invasive spine procedures are becoming well documented. However, few large studies evaluating these types of outpatient procedures have been presented. The purpose of this study is to assess the complications and two-year functional outcomes of these procedures.
Results: Of the 3,958 procedures performed, there were 0 (0.00%) mortalities, 1 (0.00%) cardiopulmonary arrest, 5 (0.13%) surgical site infections, 2 (0.00%) medication errors, 12 (0.30%) hospital admissions, and 67 (1.69%) dural leaks. As presented in the poster, there were significant VAS and ODI improvements seen at 12 weeks and maintained throughout two years. In addition, outside of General Health, significant improvements were seen in all SF36 categories. Finally, 59%, 73%, 80%, 80% and 82% of patients reported return-to-work 2 weeks, 6 weeks, 12 weeks, 12 months, and 24 months post surgery, respectively.
Conclusions: Minimally invasive spine surgery can be safely and successfully performed in an outpatient setting. Outcomes data suggest significant improvements in pain relief, quality of life and level of disability. Early return-to-work offers a significant advantage to minimally invasive outpatient spine surgery.
Incisional surgical site infections (SSIs) have been reported after 2-6% of all spinal surgeries in published studies. The incidence is reported as low as less than 1% after decompression procedures and as high as 10% after instrumented fusion procedures. In a recent retrospective review of minimally invasive spine procedures, where the procedures were performed under standard sterile conditions with preoperative antibiotic prophylaxis through a tubular retractor system, the total SSI rate was reported to be 0.3%.1
At Laser Spine Institute, our SSI rate for minimally invasive spine surgeries has been described to be well below these published averages, running approximately 0.3%.
Since opening our 2nd and 3rd ASCs in 2009, we have regularly benchmarked our SSI rate internally, comparing infection rates between the facilities on a quarterly basis as a way to provide early identification and resolution of potentially significant variations in infection rates.
During the 2nd and 3rd quarters of 2009, one of our facilities completed 784 minimally invasive spine surgeries, with a rate of SSI of 0.76%. Comparatively, our other facility completed 1,590 minimally invasive spine surgeries, with a rate of SSI of 0.06%. Since both Centers perform the same types of procedures and have similar patient demographics, this variation in SSI rate was of immediate concern for the nursing and medical staff.
A multi-disciplinary team was formed, and a focused review was performed to evaluate infection prevention measures at both Centers as a result of this internal benchmarking study. A presentation of the findings, which included a significant variation in the postoperative dressing change procedure between the two facilities, was provided to the nursing and medical practitioners at the facility with the higher SSI rate. Corrective measures to standardize the postoperative dressing change procedure between the two Centers were undertaken.
At the end of the 4th quarter of 2009, after standardizing and re-educating staff on the postoperative dressing change procedure, the internal benchmark study for SSI was repeated. Both facilities reported 0 infections. Both facilities remained at 0 infections through the following quarter as well.
Regular internal benchmarking activity can provide a sensitive tool for identifying variations in rates of SSI as well as measuring results of interventions aimed at reducing variations in infection rate between facilities, within a facility, and overall. It also serves as a model for capturing and correcting other variations in care between our facilities which can impact overall quality of care.
1O,Toole, E.; Eichholz, K.; & Fessler, R. (2009). Surgical site infection rate after minimally invasive spinal surgery. Journal of Neurosurgery. 2009(11)4.
A total of 105 consecutive outpatient cervical laminotomy/foraminotomy decompression procedures were performed from October 2007 through January 2008 at one facility. A retrospective chart review including a 6 week, 12 week, 6 month and 12 month patient follow-up was performed and perioperative complications, VAS, ODI, SF36, return to work and return to daily activities are reported. Of the 105 patients in this study, a total of 87 patients (82.9%) completed a questionnaire.
* Average baseline VAS 6.36, where on a scale of 0 to 10, 5 to 6 represents moderate pain, 7 to 10 represents severe pain. Average baseline ODI 39.8, where on a scale of 100, 20 to 40 represents moderate disability.
A total of 644 consecutive outpatient lumbar laminotomy/foraminotomy decompression procedures were performed from October 2007 through January 2008 at one facility. A retrospective chart review including a 6 week, 12 week, 6 month and 12 month patient follow-up was performed and perioperative complications, VAS, ODI, SF36, return to work and return to daily activities are reported. Only patients with previous lumbar spine surgery were excluded from this data set, leaving 402 patients. Of the 402 patients in this study, a total of 312 patients (77.6%) completed a questionnaire.
* Average baseline VAS 6.41, where on a scale of 0 to 10, 5 to 6 represents moderate pain, 7 to 10 represents severe pain. Average baseline ODI 42.0, where on a scale of 100, 40 to 60 represents severe disability.
Our minimally invasive spine surgery provides many advantages vs. open back surgery.
An overview of research articles published by Laser Spine Institute surgeons and physicians.
|Minimally Invasive Procedures||Traditional Open Back Surgery|
|Hospital stay||None||2-5 Days|
|Infection rate||0.49 percent||19 percent|
1. Laser Spine Institute. Outpatient Based Minimally Invasive Cervical Laminotomy/Foraminotomy Spinal Decompression: Feasibility, Safety and Clinical Results. Presented at the American Academy of Neurological and Orthopedic Surgeons (AANOS) Annual Scientific Meeting. Montreal, Canada. 2009
2. Laser Spine Institute. Outpatient Based Minimally Invasive Lumbar Laminotomy/Foraminotomy Spinal Decompression: Feasibility, Safety and Clinical Results. Presented at the American Academy of Neurological and Orthopedic Surgeons (AANOS) Annual Scientific Meeting. Montreal, Canada. 2009