Outpatient spine surgery — Key drivers & why it won't go away

Laura Dyrda -   Print  | Email

Neil Badlani, MD, is a spine surgeon with North American Spine in Houston.

He has a professional interest in minimgally invasive spine surgery and motion-sparing techniques, including disc replacement. Here, Dr. Badlani discusses the advantages of outpatient spine surgery and where these techniques are headed in the future.

Q: What are the most important innovations in outpatient spine today?


Dr. Neil Badlani: Minimally invasive spine surgery is becoming more successful and more common for a variety of reasons. These procedures can be done with smaller incisions, less muscle disruption, less blood loss, less postoperative pain and therefore a faster recovery for the patient.


Tubular retractor systems with specialized instruments and high powered microscopes or endoscopes allow procedures to be done in this fashion. Better instrumentation including more percutaneous instrumentation and standalone interbody cages are important advancements. Alternative approaches to the spine such as the lateral approach or mini-open anterior or oblique approaches allow access to the spine without significant disruption of muscle.


Perhaps more importantly, as surgeons we are doing a better job of utilizing all of these tools and understanding the many factors necessary to do these procedures in a less invasive fashion. Patient education is critical to establish and manage a patient's expectations about recovery after surgery. We are also working more with our anesthesia colleagues to utilize multimodal pain control methods to allow spine surgery to be done safely in the outpatient setting.

Q: What new technologies or devices could make an impact on outpatient spine in the future?

NB: Spine surgery is still a frontier with constantly advancing technology. Robotic spine surgery will likely continue to become more common and make a bigger impact on less invasive spine surgery. We can expect continued advancements in instrumentation and spinal devices. New technologies that help minimize blood less during spine surgery such as the use of tranexamic acid or transcollation technology will make an impact.

Q: How can spine surgeons optimize their outpatient procedures? What do they need to know about transitioning cases from inpatient to outpatient?

NB: Patient education and patient selection is the most important aspect of this. Patients should be willing and motivated to have an outpatient procedure and interested in a quicker recovery. When transitioning surgery from the inpatient to the outpatient setting, it is prudent to have a stepwise approach and start with more straightforward procedures in healthier patients first and expand indications later. It is safe to have the option to admit to an inpatient facility if necessary particularly early on in the process.

Q: Where do you see the biggest opportunities in outpatient spine in the future?

NB: Currently lumbar decompression and anterior cervical procedures are commonly done in an outpatient setting. Expanding to minimally invasive lumbar fusion is the biggest opportunity and can certainly be done with the right patient, surgical team and careful approach.

Q: Will more spine surgeons be performing cases in outpatient ambulatory surgery centers five years from now?

NB: Absolutely the trend toward outpatient spine surgery and minimally invasive spine surgery will continue to grow. More surgeons are continuing to adopt and expand these techniques. There is a great benefit to our patients because of less pain, less blood loss and faster recovery. Also, with the continued emphasis on controlling health care expenditures, it is important to transition procedures to the outpatient setting.


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