A single-center, retrospective study.
To determine the safety and outcomes of total disc replacement (TDR) as an outpatient procedure in the ambulatory surgery center (ASC).
Anterior cervical discectomy and fusion (ACDF) has been demonstrated to be safe in the outpatient setting. As the awareness of same day surgery procedures is on the rise due to better outcome and shorter recovery time. There is a need for motion preservation in a subset of patients total disc replacement provides a solution. Transitioning spine surgery to the outpatient setting including cervical TDR is the next logical step.
The medical records of 55 consecutive patients undergoing single level total disc replacement (Group 1) were compared to our control group of 55 patients who had single-level ACDF (Group 2). Outcomes assessed included VAS neck, arm, NDI scores, and complication rate.
55 patients in Group 1 (TDR) 60% were male with the group's mean age being 42.6+/- 1.4 years and BMI 24.8+/-1.2 kg/m. 55 patients in Group 2 (ACDF) 57% were male with the group's mean age being 53+/-1.0 years and mean body mass index (BMI) 27.9+/-0.8 kg/m. There was no statistically significant intergroup difference in two year VAS neck, arm and NDI scores. Dysphagia was the most common postoperative compliant in both groups (6 patients), with no intergroup significance, p = 0.4.
In the ambulatory setting, TDR has shown statistical significant intragroup improvement in VAS neck, arm pain scores and NDI scores (p < 0.001). In this study no patients reported serious complications; no incidence of hematoma formation or worsening postop pain. We conclude that single level TDR can be safely done in an ambulatory surgery center with satisfactory clinical and patient-reported outcomes. This is comparable to single level ACDF in the outpatient setting and previous 2 year TDR studies.
3.