By Dr. Kingsley Chin
Interested medical professionals can read through the full paper, as published in Spine, here.
A single-center, retrospective study.
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.
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.
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.
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
About Author Dr. Kingsley R. Chin
Dr. Kingsley R. Chin is a board-certified Harvard-trained Orthopedic Spine Surgeon and Professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, Visiting Spine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Sciences at the University of Technology, Jamaica.
About Less Exposure Surgery
Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.
The LES Society philosophy: “Tailor treatment to the individual aiding in the quickest recovery and return to a pain-free lifestyle, using LES® techniques that lessen exposure, preserve unoffending anatomy and utilize new technologies which are safe, easy to adopt and reproducible. These LES®techniques lessen blood loss, surgical time and exposure to radiation and can be safely performed in an outpatient center. Less is more.” – Kingsley R. Chin, MD
About The LESS Institute
The LESS Institute is the world leader center of excellence in Less Exposure Surgery. Our safe, effective outpatient treatments help patients recover quickly, avoid expensive hospital stays and return home to their family the same day. Watch our patient stories, follow us on Facebook and visit TheLESSInstitute.com to learn more.
The above study utilized LES Technology from SpineFrontier – leading provider of LES Technologies and instruments – offering surgeons and patients superior technology and services.
Scientific Paper Author and Citation Details
*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.