Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital
Objective The objective of this study was to examine a spine naïve community hospital’s ability to perform MITLIF safely and with speedy discharge via implementation of a minimally invasive spine surgery (MISS) program utilizing ERAS. Methods Single community hospital retrospective cohort analysis f...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Korean Minimally Invasive Spine Surgery Society
2022-10-01
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| Series: | Journal of Minimally Invasive Spine Surgery and Technique |
| Subjects: | |
| Online Access: | http://www.jmisst.org/upload/pdf/jmisst-2022-00507.pdf |
| _version_ | 1797951428110581760 |
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| author | Jonathan F Dalton Anthony Oyekan Dominic Ridolfi Emmett Gannon Ethan Ruh Vivek Sharma |
| author_facet | Jonathan F Dalton Anthony Oyekan Dominic Ridolfi Emmett Gannon Ethan Ruh Vivek Sharma |
| author_sort | Jonathan F Dalton |
| collection | DOAJ |
| description | Objective The objective of this study was to examine a spine naïve community hospital’s ability to perform MITLIF safely and with speedy discharge via implementation of a minimally invasive spine surgery (MISS) program utilizing ERAS. Methods Single community hospital retrospective cohort analysis for initial consecutive MITLIF cases with unilateral pedicle screws performed by a single surgeon from October 2019 to March 2021. Minimum postoperative follow-up was one year. Narcotic use was assessed per the state prescription drug monitoring program. Surgery protocol included single paraspinal incision, non-expandable 18/22 mm tube, operating microscope, fluoroscopic guidance, EMG with SSEP monitoring and Enhanced Recovery After Surgery (ERAS) protocol. Results 52 patients were included. Average OR time, and fluoroscopy time were 143±115 minutes, and 1.00±0.47 minutes, respectively. Patients were prescribed an average of 38±33 post-operative opioid doses for an average of 8±7 days. All patients on preoperative, chronic narcotics had no prescription changes, pre-op versus post-op, despite clinical improvement. Complications included one irrigation a(1.9%) nd debridement with retention of hardware for surgical site infection, and one revision(1.9%) for displaced hardware. Discharge data included 47 (90.4%), four (7.7%), and one patients (1.9%) discharged on POD1, POD2, and beyond POD2, respectively. Conclusion MITLIF can be safely and successfully performed at a spine naïve community hospital with excellent intraoperative metrics, a low complication rate, and speedy discharge. MITLIF performed well in multiple perioperative and postoperative variables compared to MISS techniques. Considerations for implementation of MITLIF in the community setting include special equipment, personnel training, surgeon experience, ERAS protocols and diligent patient/indication selection. |
| first_indexed | 2024-04-10T22:30:26Z |
| format | Article |
| id | doaj.art-2063f59cde2749dbaf71f1e5e8462a49 |
| institution | Directory Open Access Journal |
| issn | 2508-2043 |
| language | English |
| last_indexed | 2024-04-10T22:30:26Z |
| publishDate | 2022-10-01 |
| publisher | Korean Minimally Invasive Spine Surgery Society |
| record_format | Article |
| series | Journal of Minimally Invasive Spine Surgery and Technique |
| spelling | doaj.art-2063f59cde2749dbaf71f1e5e8462a492023-01-17T04:46:10ZengKorean Minimally Invasive Spine Surgery SocietyJournal of Minimally Invasive Spine Surgery and Technique2508-20432022-10-017225926510.21182/jmisst.2022.00507148Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community HospitalJonathan F Dalton0Anthony Oyekan1Dominic Ridolfi2Emmett Gannon3Ethan Ruh4Vivek Sharma5 Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA Department of Orthopaedic Surgery and Rehabilitation, Nebraska Medical Center, Omaha, NE, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USAObjective The objective of this study was to examine a spine naïve community hospital’s ability to perform MITLIF safely and with speedy discharge via implementation of a minimally invasive spine surgery (MISS) program utilizing ERAS. Methods Single community hospital retrospective cohort analysis for initial consecutive MITLIF cases with unilateral pedicle screws performed by a single surgeon from October 2019 to March 2021. Minimum postoperative follow-up was one year. Narcotic use was assessed per the state prescription drug monitoring program. Surgery protocol included single paraspinal incision, non-expandable 18/22 mm tube, operating microscope, fluoroscopic guidance, EMG with SSEP monitoring and Enhanced Recovery After Surgery (ERAS) protocol. Results 52 patients were included. Average OR time, and fluoroscopy time were 143±115 minutes, and 1.00±0.47 minutes, respectively. Patients were prescribed an average of 38±33 post-operative opioid doses for an average of 8±7 days. All patients on preoperative, chronic narcotics had no prescription changes, pre-op versus post-op, despite clinical improvement. Complications included one irrigation a(1.9%) nd debridement with retention of hardware for surgical site infection, and one revision(1.9%) for displaced hardware. Discharge data included 47 (90.4%), four (7.7%), and one patients (1.9%) discharged on POD1, POD2, and beyond POD2, respectively. Conclusion MITLIF can be safely and successfully performed at a spine naïve community hospital with excellent intraoperative metrics, a low complication rate, and speedy discharge. MITLIF performed well in multiple perioperative and postoperative variables compared to MISS techniques. Considerations for implementation of MITLIF in the community setting include special equipment, personnel training, surgeon experience, ERAS protocols and diligent patient/indication selection.http://www.jmisst.org/upload/pdf/jmisst-2022-00507.pdfspineminimally invasive spine surgeryoutpatient surgeryenhanced recovery after surgerysurgery learning curvecommunity spine surgery |
| spellingShingle | Jonathan F Dalton Anthony Oyekan Dominic Ridolfi Emmett Gannon Ethan Ruh Vivek Sharma Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital Journal of Minimally Invasive Spine Surgery and Technique spine minimally invasive spine surgery outpatient surgery enhanced recovery after surgery surgery learning curve community spine surgery |
| title | Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital |
| title_full | Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital |
| title_fullStr | Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital |
| title_full_unstemmed | Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital |
| title_short | Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital |
| title_sort | minimally invasive transforaminal lumbar interbody fusion with enhanced recovery after surgery eras early experience with initial consecutive cases at a spine naive community hospital |
| topic | spine minimally invasive spine surgery outpatient surgery enhanced recovery after surgery surgery learning curve community spine surgery |
| url | http://www.jmisst.org/upload/pdf/jmisst-2022-00507.pdf |
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