The Safety and Efficacy of Posterior Lumbar Interbody Fusions in the Outpatient Setting

TL;DR

This study shows that a type of spine surgery called posterior lumbar interbody fusion can be safely and effectively done in an outpatient setting, leading to significant pain reduction.

Contribution

The study provides evidence that open posterior lumbar interbody fusions can be safely performed in an outpatient setting with favorable outcomes.

Findings

94.4% of patients undergoing single-level PLIF had improved Oswestry Disability Index scores by 20.4 points.

Visual analog scale scores improved by 27.2 points post-surgery.

Postoperative fusion rate was 94.4% with low complication rates.

Abstract

Introduction

Outpatient surgical procedures have shown reduced costs, improved patient outcomes, and decreased postoperative complications. Interest in moving orthopedic and neurosurgical spine procedures to the outpatient setting has grown in recent years because of these factors. Studies investigating open posterior lumbar interbody fusions (PLIFs) in the outpatient setting are sparse.

Methods

The patients who underwent an open PLIF with pedicle screw and rod construct from 2014 to 2018 were retrospectively reviewed. Outpatient procedures were defined by patient discharge being on the same day of the procedure, without admittance to an inpatient ward. Pertinent demographic, clinical, radiographic, and surgical data were collected and analyzed.

Results

The current study included 36 outpatient PLIF cases with 94.4% of the study cohort undergoing a single-level PLIF. The average Oswestry Disability Index (ODI) score improved by 20.4 points from preoperative measurements (p = 0.0002), and the visual analog scale (VAS) score improved by 27.2 points (p = 0.0001). The postoperative fusion rate was 94.4%. One intraoperative complication occurred (2.78%), and four postoperative complications occurred (11.11%). There were no subsequent admissions throughout the postoperative follow-up period; however, two of the 36 patients (5.56%) did require reoperation, both in an outpatient setting.

Conclusions

This study demonstrates that open posterior lumbar interbody fusions performed in an outpatient setting can be performed safely and effectively, with a significant reduction in VAS and ODI pain scores.