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Speaker: Less invasive approaches for lumbar fusion may be possible for select patients
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CHICAGO — Endoscopic fusion under conscious sedation may be an alternative to traditional lumbar spine fusion for select patients, according to data presented at the American Association of Neurological Surgeons Annual Meeting.
“Even less invasive approaches for fusion are possible, leveraging new technology. For select patients, this is going to work well, but it does not work for everybody. We need to incorporate the other [enhanced recovery after surgery] ERAS components, such as the diet, the psychiatric counseling, medication aspects, etc.,” Michael Y. Wang, MD, FAANS, said, here.
Michael Y. Wang
In a case series study, Wang and colleagues used an endoscopic technique for interbody fusion combined with percutaneous screws without complete general anesthesia. The first 10 consecutive patients were treated using a standard ERAS technique for single-level lumbar fusion under monitored anesthesia care. Minimum follow-up was 1 year, with all patients having clinical and radiographic follow-up of dynamic radiographs and SF-36, EQ-5D and Oswestry Disability Index (ODI) scores taken. All patients had severe disc height collapse, and 60% of patients had a grade 1 spondylolisthesis. Average patient age was 62.2±9 years.
Endoscopic access through Kambin’s triangle allowed for neural decompression, discectomy, endplate preparation and interbody fusion. This was followed by percutaneous pedicle screw and connecting rod placement using liposomal bupivacaine (Exparel, Pacira). The researchers did not use narcotics or regional anesthetics during surgery.
Wang said a successful surgery without conversion to open surgery was achieved for all patients. Mean operative time was 113.5±6.3 minutes and blood loss was 65±38 mL. Hospital length of stay was 1.4±1.3 nights. There were no intraoperative or postoperative complications. The ODI scores improved from a preoperative average of 42 to a final of 13.3. The SF-36 physical component summary and EQ-5D scores also improved.
Wang said there were no cases of nonunion on follow-up imaging and no conversions to general anesthesia or to open surgery were noted. He noted larger clinical series with longer follow-up are needed to validate the clinical improvements and that arthrodesis rates are successful when compared with open surgery. – by Kristine Houck, MA, ELS
Reference:
Wang MY, et al. Paper #601. Presented at: American Association of Neurological Surgeons Annual Meeting. April 30-May 4, 2016; Chicago.
Disclosure: Wang reports he is a consultant for DePuy Spine, Aesculap Spine, Spinicity, JoiMax and K2M; receives financial or material support from DePuy Spine and Neuro Consulting LLC; is a stock shareholder for Neuro Consulting LLC and the U.S. Department of Defense; receives university research support from Quality Medical Publishing; and receives honorarium from JoiMax.