ORLANDO, Fla. — Patients who underwent minimally invasive transforaminal lumbar interbody fusion under conscious sedation, in which no regional anesthetics or narcotics were used as part of a program to enhance recovery after surgery, sustained no intraoperative or postoperative complications. In addition, they had no signs of nonunion on follow-up imaging, according to a presenter, here.
At Spine Summit 2016: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting, Michael Y. Wang, MD, FACS, presented the 2-year results for 10 consecutive patients he and his colleagues treated with “awake” endoscopic transforaminal lumbar interbody fusion. Wang said the series of patients treated with this approach now totals nearly 50 patients.
Michael Y. Wang
The patients included in the study were carefully selected for the enhanced recovery after surgery (ERAS) protocol and mostly had severe disc height loss or grade 1 spondylolisthesis. For the group in which the ERAS protocol was used, “it is tremendously different in terms of the patient experience. In about 80% of patients, it is almost like they did not have an operation,” Wang said.
He also emphasized the importance of patient selection.
“When you pick the right patients, [there is an] Oswestry Disability Index drop of almost 30 points on average, which is pretty good,” he said.
The other five components of the ERAS protocol in spine surgery that Wang discussed are endoscopic visualization, the use of small percutaneous screws with small incisions, Exparel (bupivacaine liposome injectable suspension, Pacira Pharmaceuticals Inc.), use of an expandable interbody cage and the application of bone morphogenetic protein.
In time, the cost-savings data related to these procedures may reveal more benefits, he said.
“Really less-invasive methods are coming. It is going to important to select these patients out, and we need long-term follow-up and bigger series,” Wang said. — by Susan M. Rapp
For more information:
Wang MY, et al. Paper #185. Presented at: Spine Summit 2016: CNS/AANS Section on Disorders of the Spine & Peripheral Nerves Annual Meeting; March 16-19, 2016; Orlando, Fla.
Disclosure: Wang reports he is a consultant to Aesculap Spine, DePuy Spine, Joimax and K2M, and receives intellectual fees from DePuy Spine.