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2013년 10월 7일 월요일

Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.

Brief review


*Title: Preliminary results on feasibility of outpatient instrumented transforaminal lumbar interbody fusion.
외래환자의 신경공경유요추체유합술 시행 가능성에 대한 예비결과

*Author: Alan T. Villavicencio, Ewell Lee Nelson, Alexander Mason, Sharad Rajpal, Sigita Burneikiene




STUDY DESIGN: A retrospective chart review study

OBJECTIVE:
-The primary objective: To examine whether it is safe and effective to perform instrumented lumbar interbody fusions by comparing 2 groups (same day vs stayed overnight).

-The secondary objective: To identify the need for prolonged observation for complications that may occur in the immediate postoperative period.


SUMMARY OF BACKGROUND DATA
There is currently no information in the literature on the safety and complication rates of instrumented transforaminal lumbar interbody fusions performed in an ambulatory surgery setting.


METHODS:
Subject number: Ambulatory Surgery Center(ASC): 27/  Hospital Outpatient Departments (HOD): 25

Mean age: 49.8 years (19-72 y)

evaluation method:
-The safety of outpatient lumbar fusions: analyzing complications that occurred when the seventh postoperative day (0-7 POD).
- The efficacy of surgical intervention: change in pain, patient satisfaction scores, and fusion rates


RESULTS:
-no cases of pneumonia, urinary tract infection, or thromboembolic complications.

-4 patients(14%) in ASC and 1 patient(4%) in HOD had complications within 7 days postoperatively.
-->not statistically significant in difference (P=0.36, Fisher exact test).

-Lower back and leg pain was significantly (P<0.0001) decreased postoperatively as follow.
>The average back pain: 74.5 (range: 0-100)  --> 18.8 (range: 0-90)
>The average leg pain: 54.2 (range, 0-100) --> 9.1 (range, 0-60)
*using 0-100 visual analog scale



CONCLUSIONS: 
This study discusses the possibility of performing instrumented lumbar interbody fusions with the transforaminal lumbar interbody fusion technique as an outpatient procedure.