1. 2017;20;E221-E231Full-Endoscopic Assisted Lumbar Decompressive Surgery Performed in an Outpatient, Ambulatory Facility: Report of 5 Years of Complications and Risk Factors
   Retrospective Review
   Solomon Kamson, MD, PhD, Andrea M. Trescot, MD, Paul D. Sampson, PhD, and Yiyi Zhang, BS.

BACKGROUND: Minimally invasive surgery (MIS) technique is becoming the standard tissue sparing approach for decompression of lumbar central and lateral recess stenosis, intervertebral disc herniation, or any situation that would have required extensive open decompression laminectomy. Full-endoscopic or arthroscopic assisted surgery is arguably the “ultra-MIS” approach to lumbar spinal pathology. Age and body mass index (BMI) are significant risk factors to be considered in full-endoscopic assisted ultra-MIS. With limited medical literature published on complication rates for MIS, reports on the ultra-MIS approach are even scarcer for free-standing, outpatient ambulatory settings.

OBJECTIVES: The primary goal of this study is to compare outcomes for full-endoscopic assisted ultra-MIS lumbar decompression surgical techniques, performed in a free-standing, outpatient ambulatory facility, with other spine surgery techniques.

STUDY DESIGN: This is a Western Institutional Review Board (WIRB)-approved retrospective review of prospectively collected patient demographic and outcomes data for full-endoscopic assisted interlaminar and transforaminal lumbar decompressive surgery.

SETTING: Free-standing, outpatient ambulatory surgery facility.

METHODS: A population of 178 patients, whose age ranged between 16 and 90 years old (mean 45.5 years), with a variety of clinical presentation of symptoms underwent lumbar decompressive surgery using an interlaminar or transforaminal full-endoscopic assisted approach between January 2011 and December 2015. Operative (OR) time, complication rates, estimated blood loss, preoperative and postoperative leg and back VAS, and patient satisfaction ratings at 6, 9, and 12 months post operation are reported.

RESULTS: Age is a significant predictor of OR time; older patients generally have longer surgeries. BMI does not have statistically significant effect on OR time; heavier patients have similar OR time as other cohorts. There were no reportable intra-operative complications in this series of 178 patients. There were 3 major (1.69%) and three 3 (1.69%) postoperative complications. The 3 major complications were all incidences of early postoperative reherniation that resulted in re-operation. The minor complications included 2 cases of sympathetically mediated pain syndrome and one case of postanesthetic transient urinary retention. About 95% of patients had less than 5 mL of blood loss. No patients lost more than 35 mL of blood during surgery. Visual analog scale (VAS) score dropped from 7 to 3, on a scale of 0 to 10 with 10 being the worst pain imaginable, within 2 months postoperative. On average, 70% to 80% of patients were satisfied or greatly satisfied with the surgery, and 85% to 92% of patients would recommend this type of surgery.

LIMITATIONS: Retrospective study.

CONCLUSIONS: Full-endoscopic assisted ultra-MIS technique is a viable option for lumbar decompressive surgery in a free-standing, outpatient ambulatory facility. The patient population in this study demonstrates its safety, efficacy, and effectiveness for treatment of various lumbar pathologies. It is particularly relevant that age and obesity are not contra-indications.

Key words: Full-endoscopic, minimally invasive spine surgery, postoperative complications, lumbar discectomy, lumbar decompression, lumbar disc herniation, spinal stenosis, endoscopic discectomy, ultra-MIS, arthroscopic