Transitioning lumbar fusions to outpatient using midline less exposure surgery techniques with transfacet and mediolateral cortical bone pedicle screws

Abstract

Objective:Posterior decompression and fusion have been the standard of treatment for degenerative disc disease as well as disc herniation. Recent advances in medicine and healthcare have shown a trend to move surgeries to the outpatient setting. The authors aim to assess the outcomes of unilateral cortical pedicle screw-rod construct combined with a contralateral transfacet pedicle screw (TFPS) in the outpatient setting. Methods:The medical records of 40 patients with prospectively collected data were retrospectively reviewed. Two cohort groups, bilateral traditional pedicle screws consisting of 20 patients and unilateral pedicle screw (UPS) rod construct with a contralateral transfacet pedicle screw (TFPS) consisting of 20 patients were created. Outcomes assessed include demographic age and body mass index (BMI). Functional visual analog scale (VAS) pain and owestry disability index (ODI) scores as well as, the complication rate was also assessed. Results:There were 24 males and 16 females, age range 28-65 years average 59.3 ± 2.3 years, with an average BMI of 28.6 ± 0.9 kg/m2 . There was a significant improvement in pre-operative VAS and ODI in both groups, however, there was no intergroup significance p= 0.733 and 0.093, respectively. The most common complaint was dermatome numbness which was present pre-operative but persisted for six months postoperatively. Conclusion:Combined unilateral pedicle screw with a contralateral facet screw (UPFS) has a similar safety profile with improvement in VAS and ODI postoperatively. This technique is an alternative that can be performed based on surgeon preference.