Back

245 Views

Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

The Implementation of Minimally Invasive Spine Surgery at a UPMC Peripheral Community Hospital

Thursday, November 10, 2022

3:16 PM – 3:21 PM

Location: Station 4

Presenting Author(s)

YT

Yunting Tang, NA

Resident Physician
University of Pittsburgh
Pittsburgh, Pennsylvania, United States

Non-presenting Author(s)

AO

Anthony Oyekan

Resident Physician
Department of Orthopaedic Surgery
Pittsburgh, Pennsylvania, United States
JD

Jonathan Dalton
DR

Dominic Ridolfi
VS

Vivek Sharma, MD

Clinical Associate Professor
Department of Orthopaedic Surgery UPMC, United States

Research Objectives: To investigate the initial clinical experiences of a spine surgeon performing unilateral lumbar laminectomy with bilateral
decompression (ULLBD) via MISS at a UPMC peripheral community hospital with no previous in-house spine
service.

Design: With review board approval, a retrospective review of a prospectively collected database was performed. The minimum postoperative follow-up was 1 year.

Setting: All elective ULLBD cases by a single fellowship-trained orthopedic spine surgeon from October
2019 to March 2021 at a non-teaching UPMC community hospital with no previous in-house spine coverage
were included.

Participants: 55 patients were included in the analysis (32 F, 23 M; age 65 ± 17 years, BMI 30.0 ± 6.1)

Interventions: Patients who underwent a ULLBD were indicated for instrumented posterior spinal fusion by pre-operative dynamic instability and iatrogenic instability associated with the decompressive procedure.

Main Outcome Measures: Data collected included patient demographics, diagnoses, discharge date, discharge disposition, and narcotic use.

Results: 51 (92.7%) patients were on discharged postoperative day 1, 3 (5.5%) patients discharged on postoperative day 2, and only
1 (1.7%) patient discharged after postoperative day 2. 53 (96.3%) patients were discharged to home and only 2
(3.6%) required a skilled nursing facility. Notably, all patients on chronic narcotics had no change from
preoperative prescriptions despite continued clinical improvement. There were no complications that required
re-operation.

Conclusions: Minimally invasive spine surgery may be safely implemented at a peripheral community hospital with excellent outcomes.
Instrumented posterior spinal fusion for ULLBD was generally performed in older patients with spondylolisthesis and required greater OR time, radiation dose, blood loss, and narcotic prescription doses than patients without instrumented fusion.
ERAS protocols may improve perioperative restrictions, pain control, and rehabilitation. Considerations include equipment, personnel training, and surgeon experience. ULLBD may be successfully implemented and performed in MISS-naïve hospitals with excellent outcomes.

Author(s) Disclosures: None

Learning Objectives:

Upon completion, participants will be able to evaluate the safety and efficacy of implementing a minimally invasive spine surgery program at a community hospital.
Upon completion, participants will be able to assess the correlation between recovery and discharge with implementation of a minimally invasive spine surgery program at a community hospital.
Upon completion, participant will be able to appraise the initial clinical experiences of a spine surgeon performing unilateral lumbar laminectomy with bilateral decompression (ULLBD) via MISS at a community hospital.