Surgery to remove degenerated discs in the neck can be performed safely in outpatient

Surgery to remove multiple herniated or degenerated discs in the neck, a procedure known as anterior cervical discectomy and fusion (ACDF), can be safely performed in ambulatory settings in some patients, according to a study conducted at the clinic. 39 Hospital for Special Surgery (HSS) New York City.

The research, titled "Comparison of Multilevel Cervical Discectomy and In-Hospital and Outpatient Fusion," was presented today at the annual meeting of the American Academy of Orthopedic Surgeons in Toronto. Las Vegas.

"The focus on reducing healthcare costs has led to many surgeries in a wide range of outpatient specialties," said Sheeraz Qureshi, Patty and Jay Baker Chair in Minimal Spine Surgery -invasive. "One-level ACDF, in which a disc is removed, is one of the most common spine surgeries performed on an outpatient basis."

ACDF can be practiced when pain persists and non-surgical treatments provide no relief. The procedure involves removing the damaged disc (s) as well as the developed bone spurs. Once the disc is removed, a bone graft is inserted into the open space. The graft serves as a bridge between the two vertebrae to create a vertebral fusion. To relieve symptoms, the surgeon can remove a disc (ACDF at one level) or multiple discs (ACDF at multiple levels).

Despite ACDF's success at an ambulatory level, concerns about the increasing number of postoperative complications, including respiratory problems, have limited the performance of the multi-level ACDF system in outpatient settings, according to Dr. Qureshi. Together with his colleagues, he has attempted to compare the preliminary results and the safety of a multilevel ACDF in the context of inpatients and outpatients, by examining various patient and procedural factors.

The study included patient demographics; initial differences between patients, such as additional health problems; blood loss; operating time; the length of stay in the hospital; and complications. The researchers also compared the results reported by the patients, who evaluated the improvement of pain, function and well-being from the patient's point of view.

Of the 103 patients in this study, 57 were outpatients and 46 were hospitalized. Inpatients were older (median age 57 versus 52).

Ambulatory surgery was more common when fewer discs were removed. Of the 83 cases of ACDF at two levels, 60.2% were outpatient surgeries. Of the 20 cases at three levels, 35% were outpatients. Ambulatory patients had shorter operative times (71 minutes versus 84 minutes) and significantly shorter hospital stay (8.5 hours versus 35.8 hours). There was no difference in postoperative pain.

At the six-month follow-up, both groups reported a significant improvement in pain and function.

"In our study, the surgical context did not have an impact on the results reported by patients." The findings suggest that a multilevel ACDF can be safely performed in ambulatory settings without increased risk. complications in appropriately selected patients, "noted Dr. Qureshi. "In particular, the age of the patient, his or her additional health issues and the number of levels merged must be taken into account in deciding on the achievement of a multilevel ACDF outpatient."