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Safety and reproducibility of Total Cervical Disc Replacement in an Ambuatory Surgery Center
Nitin Khanna MD, FAAOSMichael Krzyskowski PA
www.nkspine.com
History of Spine Surgery
� Long procedures with high complication rate- “Don’t let anyone operate on your spine”
� Advanced technology and goal to improve outcomes with shorter recovery periods – key US surgeons leading minimally invasive spine surgery.
� Key concept – God built the patient better than I can fix them
Cervical Disc Replacement
� Replace cervical discs instead of fusing – Largest experiences in the Region
What are we doing now – Why?
● Most Surgeons still use over top cervical plates
● Adjacent segment disease and potential for constriction of the esophagus are at higher risk
● Compare to zero-profile ACDF
Case Example
● 50 year old male ○ 3 months neck
pain, arm pain and weakness
2 weeks postop
● Same day stay in hospital○ Taking 1 Norco every 6
hours● Arm pain resolved - neck
soreness● Soft collar for 2 weeks only● Released to work without
restrictions at 2 weeks
Patient Selection
� Must ensure that the patient is motivated to improve – the best surgery in the wrong patient will not work
� Focus on one level and ensure the other segments are in excellent condition
Methods
� Single surgeon, single center
� Retrospective Chart review� 16 one-level disc replacement, 2 two-level replacements
� 18 consecutive patients� Demographics
� Age, sex, BMI, third party payer
� PACU time
� Comorbidities
� 30 day readmission, infection, blood transfusion
Results
� Demographics� Average age 45.6 (33-57)� 12 male, 6 female� Average BMI 30.0 (23.0-43.1)� 12 private insurance, 6 worker’s compensation
� Comorbidities:� HTN (8), GERD (5), ex-smoker (5), hypothyroidism (4), smoker
(2)� 7 w/ sole comorbidity of: leukemia, h/o esophageal cancer, h/o heart
murmur, h/o hepatitis C infection, glaucoma, arthiritis, diabetes� Average length of stay - 93.9 minutes (54-133)� No infections were noted, no patients required a blood
transfusion or 30-day readmit
Conclusions
� Based on our small data set –Cervical Disc Replacement is safe and reliable procedure in the ambulatory surgery center setting
� Further multicenter studies need to be performed to confirm that this a generalizable findings as all the cases were performed by the senior author
� Patient selection and excellent workflow across disciplines in the Ambulatory surgery center are key to reproducible and safe results.
May 2019 -
� Disc replacement length of stay < 1 day
� No significant difference:� Readmit rate� perioperative adverse � events
� Single level TDR is safe in the outpatient setting
Thank you
Thank you
Questions?
Nitin Khanna, MDMichael Krzyskowski, PA-Cwww.nkspine.comwww.osni.org