Many spine procedures needed to treat patients with common spine problems encountered in our working bipedal world required the following: a 3-5 day stay in the hospital, large painful muscle-stripping incisions, the harvesting of bone graft, with a 30%-40% chance of continued pain up to 2 years after surgery at the graft site, and rehabilitation in the hospital before a patient could be discharged to home. Mercifully, these same procedures germane to cervical and lumbar surgery have evolved to our advantage.
Innovative advances in the technology of spinal fixation and instrumentation, clinical use of bone morphogenic proteins (BMP) and bone substitutes have allowed spine surgeons to develop minimally invasive spinal (MISS) procedures. The goal of these procedures is less operative trauma to the normal anatomic soft tissues while correcting spinal pathology. Patients, therefore, can return to their activities of daily living quickly with minimal pain and discomfort. This translates into less cost, disability, and time lost from work associated with the treatment of spinal pathology. A facility that can provide efficient and timely diagnosis, treatment and management of a largely industrial population will contribute directly to a company’s bottom line – prompt return of their employee’s to gainful employment.
Straightforward spine procedures such as single level anterior cervical fusion and microlumbar discectomy are being done frequently in surgery centers on an outpatient basis. The impetus to do more advanced cases employing the above technology is now available. Soon single level laminectomy’s, posterior cervical foraminotomies, PLIF’s and ALIF’s will join the list. Thus, with proper patient selection and education, liberal use of pre-emptive and post-operative analgesia many MISS procedures can be done on an outpatient or 23 hour short-stay basis. And, as more spine surgeons become comfortable doing these types of procedures in this environment, outpatient spinal surgery could rapidly become the standard of care.
The future of spine surgery remains bright and exciting. The correct use of the above technology will take the field of spine surgery into a new era. Our patients will have better results, less pain and morbidity with return to a productive life with minimal delay.