Spine Surgery Experience at the Loveland Surgery Center

Loveland, Colorado

Kenneth A. Pettine, M.D., M.S.

• I.D.E. Site For Eight F.D.A. Spinal Implant Studies

• Joint Commission Accredited

Spine Surgeons – 2 (3) E.N.T. Surgeons –2 Orthopedic Surgeons –2 Pain Specialists –1 (2)

Loveland Surgery Center

Spine Surgery Definitions

Lumbar Spine Surgery – two broad categories Leg Pain Surgery

Nerve Decompression for Stenosis (Older Patient) Discectomy for Herniated Disc (Younger Patient)

Back Pain Surgery Fusion: Pedicle Screws (Posterior Approach) Artificial Disc (Anterior Approach)

Cervical Spine Surgery- Arm and/or Neck Pain –Anterior Cervical Fusion Posterior Cervical Surgery is rare

Equipment Requirements

General Surgeon

Cell Saver

Implants

C-Arm

Cloward or Equivalent TableC-ArmRetractors/KerisonsHigh Speed BurrImplants –Screws/Rods/CagesBone GraftCell SaverDural Tear Instruments

Posterior Lumbar Interbody Fusion (P.L.I.F.)

Anterior Lumbar Artificial Discs/Fusion (A.L.I.F)

Anterior Cervical Fusion (A.C.F) or Artificial Disc Replacement

C-Arm

Implants

Bone Graft

Specialized Retractors

High Speed Burr (Possible)

Lumbar Spine Decompression

Dural Tear Instruments

Cloward or Equivalent Table

C-Arm

Retractors

Kerisons

No Implants

Spine Implant Costs

Facility Fee Case Rate For

ACF- $6,500.00 PLIF- $8,500.00

Implant Costs ACF

1 Level - $4,500.00 2 Level - $7,325.00

PLIF 1 Level - $21,000.00 2 Level - $32,000.00 3 Level - $44,200.00

The Spine JournalThe Spine Journal

7 (2007) 148-153

The safety of instrumented outpatient anterior cervical discectomy and fusion

Alan T. Villavicencio, MD, Evan Pushchak, BA, Sigita Burneikiene, MD, Jeffrey J. Thramann, MD.

SpineSPINE

Volume 32, Number 10, pp 1135-1139

Outpatient Lumbar Spine Decompression in 233 Patients 65 Years of Age or Older

Natalie M. Best, BS, and Rick C. Sasso, MD.

Spine Surgery At Ambulatory Surgery Center

Anterior Cervical Fusions (One Level, Possible Two and Three)

Lumbar Nerve Decompressions

Discectomies

Spine Surgery at Ambulatory Surgery Center with Convalescent License

Lumbar Fusions Anterior/Posterior

Lumbar Artificial Disc Replacement

Instrumented Spine Surgery375 Patients

(Every Instrumented Spine Surgery Analyzed, Between Spring 2003 And Spring 2006)

Anterior Cervical Fusion 1 Level : 87 Patients 2 Level : 63 Patients

Posterior Lumbar Fusion 1 Level : 84 Patients 2 Level : 50 Patients 3 Level : 12 Patients

Lumbar Artificial Disc : 61 Patients

Results of Anterior Cervical Fusions (ACF) (148 Patients)

Time In OR 1 Level : 81.72 Min. (87 Patients) 2 Level : 84.43 Min. (61 Patients)

Time In PACU 1 Level : 92.54 Min. 2 Level : 80.80 Min.

Convalescent Care 1 Level : 20.68 Hours 2 Level : 20.33 Hours

Peri-Operative Complications = NoneUnplanned Transfers = None

63.27

24.63

7.52.71

0

10

20

30

40

50

60

70

Neck Disability Index Visual Analog Scale

Pre-op

Post-op

63.97

41.96

7.884.07

0

10

20

30

40

50

60

70

Neck DisabilityIndex

Visual AnalogScale

Pre-op

Post-op

Mean Change From Pre-op to One-Year Post-op in Patients

Undergoing One-Level ACF

Mean Change From Pre-op to One-Year Post-op in Patients Undergoing

Two-Level ACF

Patient Satisfaction Rates One Level ACF

Convalescent care room: 95% (CCR) Pain control: 98% (PC) Food in the convalescent care unit: 93% (Food) Nursing care: 97% (NC) Overall experience: 95% (OE)

0.95

0.98

0.93

0.97

0.95

90%

91%

92%

93%

94%

95%

96%

97%

98%

CCR PC Food NC OE

Patient Satisfaction Rates Two Level ACF

Convalescent care room: 99% (CCR) Pain control: 93% (PC) Food in the convalescent care unit: 93% (Food) Nursing care: 99% (NC) Overall experience: 96% (OE)

90%

91%

92%

93%

94%

95%

96%

97%

98%

99%

CCR PC Food NC OE

Conclusion Of A.C.F. Data

Clinical Results of Improvement in V.A.S. and N.D.I. Are Statistically Significant. A.C.F. Can Be Safely Performed With Efficacy At An A.S.C.

Lumbar Fusion146 Patients

Time In O.R.

1 Level : 157.51 Min.

2 Level : 186.09 Min.

3 Level : 213 Min.

157.51

186.09

213

0

50

100

150

200

250

1 Level 2 Level 3 Level

Lumbar Fusion146 Patients

Time In P.A.C.U.

1 Level: 77.59 Min.

2 Level: 85.79 Min.

3 Level: 91.07 Min.

77.59

85.79

91.07

70

75

80

85

90

95

1 Level 2 Level 3 Level

Lumbar Fusion 146 Patients

Time In Convalescent Unit

1 Level: 42.10 Hours

2 Level: 50.07 Hours

3 Level: 55.11 Hours

42.1

50.0755.11

0

10

20

30

40

50

60

1 Level 2 Level 3 Level

Peri-Operative Complications

Return To O.R. To Drain Fluid = 1 Patient

No Nerve Injuries, Infections, Vascular Problems

Unplanned Transfers To Hosp./Rehab Rehab Unit = 2 Patients Hospital = 1 Patient, Oxycontin Reaction

Causing Excessive Sedation

Clinical Results Of Lumbar Fusion At 1 Year Follow-Up One Level

44.1340.33

6.883.9

05

101520

2530

354045

OswestryDisability Index

Visual AnalogScale

Pre-opPost-op

Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Third-Level PLIF

Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Two Level

61.1

40.64

8.674.88

0

10

20

30

40

50

60

70

OswestryDisability Index

Visual AnalogScale

Pre-opPost-op

Mean Change From Pre-op to One-Year Post-op in Patients Undergoing Two-Level TLIF

Clinical Results Of Lumbar Fusion At 1 Year Follow-Up Three Levels

61.4

40.07

8.754.33

0

10

20

30

40

50

60

70

OswestryDisability Index

Visual AnalogScale

Pre-opPost-op

Mean Change From Pre-op to One-Year Post-op in Patients Undergoing One-Level TLIF

Patient Satisfaction RatesConvalescent Care

0%10%20%30%40%50%60%70%80%90%

100%

Room PainControl

Food NursingCare

Overall

1 Level2 Level3 Level

Conclusions

Improvement In V.A.S./O.D.I. and Minimal Complication Rates Indicate Lumbar Fusion At

One, Two, And Three Levels Can Be Safely Performed With Efficacy At An

A.S.C./Convalescent Center.

Lumbar Artificial Disc – F.D.A., I.D.E. Study

Time In O.R. (61 Patients) 100 MinutesTime In P.A.C.U. 83 MinutesTime In Convalescent 21 Hours

Peri-Operative Complications

Vascular Laceration = 1 Patient (1200cc)

Return To O.R. = 2 Patients = Replace Disc

Clinical Outcomes At 2 Year Follow-Up in F.D.A., I.D.E. Study

Statistical Improvement In V.A.S. / O.D.I.

Lumbar Artificial Disc Results Outside F.D.A./I.D.E. Study

Multi Level Patients

Single Level Patients

Outside Insurance Cost Analysis60% Savings Over Hospital Costs

Overall Conclusions

Spine Surgery Must Be CategorizedCervical Fusions/Cervical Artificial Discs/Lumbar Nerve Decompressions Can Be Performed Safely With Efficacy At An A.S.C.Lumbar Fusions/Artificial Disc Can Be Performed At An A.S.C./Convalescent UnitSignificant Cost Savings(60%) At An A.S.C. vs. A HospitalSpine Surgery Can Be A major Income GeneratorImplant Cost Contracts Are Important

Thank You!