Ambulatory vs. In-Patient One-Year Clinical and Radiographic Outcomes with a Novel Expandable Minimal-Access TLIF Device

Wednesday, February 21, 2024

Presenting Author(s)

John Paul G. Kolcun, MD

Resident Physician
Rush University Medical Center

Co-Author(s)

SA

Shahjehan Ahmad, MD

Fellow
Indiana Spine Group
Carmel, Indiana, United States
Richard G. Fessler, MD, PhD

Professor of Neurosurgery
Rush University Medical Center
Chicago, IL, US
Ryan Kelly, M.D. (he/him/his)

Resident Physician
Rush University Medical Center
Chicago, IL, US
DR

Dominick Richards, MD

Resident Physician
Rush University Medical Center
Chicago, Illinois, United States
WT

William Tobler, MD

Neurosurgeon
Mayfield Clinic, United States
Josha Woodward, MD, MCR

Neurological Spine Fellow
University of Miami
Miami, FL, US

Introduction: We evaluated clinical and radiographic outcomes in patients who underwent transforaminal lumbar interbody fusion (TLIF) using a novel expandable implant at two centers. We further compared outcomes between cases performed in an ambulatory vs. in-patient setting.

Methods: A consecutive series of patients underwent 1- or 2-level TLIF using this device at 2 centers. At one center, surgeries were conducted in a standard hospital setting or an ambulatory surgical center. We compared 1-year clinical and radiographic outcomes between ambulatory and in-patient cohorts. Categorical variables are shown as N (%); continuous variables are shown as mean±standard deviation

Results: We identified 194 patients, of whom 51 (26.3%) underwent out-patient surgery. Patients in the ambulatory cohort were younger (52.5±9.0 vs. 63.5±10.6 years, p< 0.001). There was a significant trend toward caudal operative levels in the ambulatory cohort (p < 0.001): while L4-5 was the most common level in both cohorts (54.9% ambulatory vs. 60.8% in-patient), the ambulatory cohort had significantly more surgeries at L5-S1 (33.3% vs. 17.5%) and fewer at L3-4 (9.8% vs. 21.0%).

There were no significant differences between cohorts in pre- or postoperative numeric rank scale (NRS) for back or leg pain, or Oswestry disability index (ODI), although both cohorts achieved significant improvement in all functional measures (p < 0.001). Similarly, there were no pre- or postoperative differences between cohorts in any radiographic measurement, with the exception of segmental lordosis at the operative level. Patients in the ambulatory cohort had higher segmental lordosis at baseline (p < 0.001), which was maintained postoperatively. Regardless of cohort, patients experienced significant increases in anterior and posterior disc heigh, increased foraminal height, and decreased spondylolisthesis (all p< 0.001).

Conclusion : This study demonstrates that 1-/2-level TLIF is safe and effective in an ambulatory setting using a novel, low-profile, expandable interbody device.