Archive April 2014 XV, No. 4

Yes, You Can Do Outpatient Spinal Fusion

These 4 factors are making it possible.

Sanjay Khurana


muscle-sparing techniques VIEW MASTERDr. Khurana employs minimally invasive, muscle-sparing techniques and microscopic advances to make outpatient spine fusion a reality.

Spinal fusion surgery bonds and immobilizes cervical or lumbar vertebrae to alleviate disc degeneration, instability, stenosis, scoliosis and other spinal disorders. While it has traditionally been an inpatient undertaking, recent developments are making outpatient fusion not only possible, but preferable. Here are 4 key factors driving that transition.

For lumbar fusion, the development of a minimally invasive technique through an alternative approach has enabled less traumatic access to the anterior spine. Extreme lateral interbody fusion, also known as XLIF, is exploding in popularity among spine specialists. With the patient positioned on his side, we enter through a small incision in the flank, between the lower rib margin and the iliac crest. By avoiding an abdominal incision and by dilating, not dissecting, the muscles of the back, we're able to reach the disc space, remove the damaged disc, and insert the bone graft material and fixation device with minimal trauma.

We're guided throughout the procedure by fluoroscopic imaging to visualize the spinal structure and neural monitoring to determine how close our instruments are to spinal nerves. But advances in operating microscopes' illumination and magnification really give us an aggressive view, on a plane-by-plane and tissue-by-tissue level, of our impact on the anatomy and the results we're likely to deliver. XLIF has a steep learning curve, but surgeons who are motivated to learn the technique will see a dual payoff of solid outcomes and patient satisfaction.

2. Can-do patients
Patient selection is key to safe, predictable and successful outpatient spinal fusion. There is a significant subset of the population — the young, healthy, motivated patients with limited co-morbidities who are amenable to education on outcomes and recovery, and who want to avoid the inpatient stays and associated risks of hospitals — who do extremely well.

Outpatient isn't ideal for every patient, of course. Studies suggest that those requiring fusion on more than 2 levels are better treated in hospitals, as are those with severe spinal cord compression, complicated deformities, or multiple co-morbidities such as obesity and heart disease, in order to ensure observation and access to immediate multi-specialty critical care if it becomes necessary.

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