Archive ORX Session Previews 2017

Outpatient Spine Is Surgery's Next Big Thing

Choosing the right patients and controlling costs are key.

John Liu

John Liu


OR Excellence

Outpatient spine is here, and it's going to get bigger — much bigger. The combination of innovative techniques, motivated patients, new ways to control pain and nausea, and financial incentives are going to make it too attractive to ignore. John C. Liu, MD, co-director of the USC Spine Center at Keck Medicine of USC and one of the pioneers of outpatient spine, will explain what's needed to succeed, so you don't get left behind.

The inspiration. Patients and insurance companies are both driving this trend. Patients obviously are much happier recovering at home, and insurance companies want it because it's much less expensive overall. With the advent of minimally invasive techniques and other innovations, it's become safe to get people home on the same day.

Pain control. We try to reduce the use of opiates before the operation. The more opiate na├»ve people are, the better we can control post-op pain. We also use intra-operative techniques, such as long-lasting local anesthetics or cocktails of steroids and pain medications. We pre-medicate with things like gabapentin and IV acetaminophen — membrane-stabilizing medications. We send opiates home with patients, but many patients — at least with the smaller operations — don't end up taking them.

Learning curve. We're going through a learning curve now, figuring out what the limitations are, and making sure we can deliver what we think we can deliver. But the number of operations that can be done outpatient is definitely growing. We do anterior cervical discectomies, artificial disc replacement, posterior cervical foraminotomy, posterior lumbar discectomies and lumbar decompressions, among others. Most spine operations still can't be done outpatient, but clearly there are a lot of bread-and-butter operations that can be, and we're looking to do more and more.

John C. Liu, MD

speaker profile
arrow Considered one of the pioneers in minimally invasive surgical techniques for spine.
arrow Has had nearly 100 papers published on spine procedures and other topics.
arrow Named USC teacher of the year in 2013.
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