Note from 9th annual Ortho conference in Chicago

[cherylstewart67]

Robert Nucci, MD, a surgeon at Citrus Park Surgery Center, gave a presentation titled "Minimally Invasive Outpatient Lumbar fusions and Multi-Level Outpatient Cervical Disc Replacements" at the 9th Annual Orthopedic, Spine and Pain Management-Driven ASC Conference in Chicago on June 10, 2011. Dr. Nucci discussed the benefits associated with performing spine cases in ASCs and described the far lateral interbody fusion procedure he has performed on patients in ASCs.

The main concerns surgeons have with performing spine surgery in ASCs are:
• The infection rate is lower than in hospitals
• There is less overhead cost and increased efficiency in the OR
• Shorter anesthesia time

To perform single or multi-level FLIFs, Dr. Nucci removes the disc through a small incision, inserts a mesh cage and inflates it with allograft bone. The average OR time for the procedure is 129 minutes, surgeon time is 118 minutes and recovery time is 180 minutes. The average blood loss is 141 cc and there is minimal muscle tissue disruption.

Dr. Nucci also performs cervical disc replacement in ASCs using an artificial disc. The average OR time is 92.4 minutes, surgeon time is 77.5 minutes and recovery is 140.8 minutes. Patients are under anesthesia for approximately two hours and experience average blood loss of 95 cc. He hasn't experienced any complications with that procedure

[Maria]

Ambulatory (or Ambulatory Care) Surgery Center which used to be known as outpatient surgery centers and maybe still is in some parts?

[jsewell]

Thanks Maria, I was going to ask about that. Around here they are called Outpatient Surgery Centers
judy

[cherylstewart67]

they are called that i guess in most places.

[Maria]

I used to work in an ambulatory care center which was a clinic outside the main hospital that saw an outpatient population. Not that one had to be walking in because we had a fair share of patients that came in w/motorized wheelchair.

I don't know whether in most cities unattached surgery centers are called ambulatory care surgery centers or outpatient surgery centers.. I still call the Emergency Dept. the Emergency Room as in go to the ER now vs. go to the ED now. No matter how many times I see ED in print I just can't get into calling it that.

[mmglobal]

This fusion technique sounds like the Optimesh fusions I saw many years ago at IITS meeting in San Diego. (International Intradiscal Therapy Society) They had a cadaver lab in which this technique was taught.

The mesh sac can be inserted endoscopically. It is then packed (inflated) by packing morselized bone. As I remember, the problem with this device is that the fusion rate is not that great. The implant may then function like an artificial disc. However, it is not very nicely controlled and can move, breakdown, etc...



Mark

[mmglobal]

Multi-level outpatient cervical ADR is great when there is no hematoma. The consequences of this complication are so great, and immediate surgery is required to keep this complication from becoming a tragedy. Just because you can do a procedure on an outpatient basis, does not necessarily mean it is a good idea.

Mark

[JeffreyD]

Well said, Mark. Just because U.S. hospitals are generally failing at microbial sanitation and doctors now must behave according to their bosses (insurance companies) doesn't mean the "quick and easy" is the best solution for the patient.
-Jeff

[cherylstewart67]

i would much rather be in a hospital if at all possible just in case something went wrong and i need another area of care.

[jsewell]

I would also rather be in a hospital. When I had my kyphoplasty , i had an overnight stay and my surgeon asked if i wanted to stay an additional day. The nurses told me he is the only doctor who does not do this procedure on an outpatient basis. I was glad.
judy

[ADR seeker]

This can replace most fusions and it is easier to perform and it doesn't have to fuse. It is available in the free world.

Neo Disk only requires four screws. It is minimally disruptive.

There are even better ways of doing it such as implanting it and then pumping in the silicone or a safe hydrogel. It will do everything a fusion can do but it will also do everything a real disk can do.

As to infections: There is no reason other than criminal neglect for even a single nosocomial infections to occur. They are 100% preventable. Greed and carelessness are why they occur and infect over 2 million Americans each year and kill over 100,000.

[mmglobal]

I looked seriously at the neodisc. It has been around for several years and has not created too much buzz in the industry. Many of the doctors I work with are always looking for the next promising technology. The neodisc is interesting for several reasons, but there are compromises in the design that give pause.

I sure hope that the neodisc naysayers are wrong, but after careful investigation, I elected not to consider it in my case.

Mark

[Maria]

That's the part I don't like.. only 4?? Sounds like 4 too many to me. This is just me and my screws in my spine phobia talking. I realize plenty of people do Ok with screws (and not).

[jsewell]

Maria with all my fused spine , I have so many many screws from my neck to my lumbar spine. Good thing i don't have a phobia. 4 is nothing
judy

[chiku]

Mark, was that a pic of the Optimesh fusion material that they use? It looks similar to the hacky sacks I crochet.

[mmglobal]

Yeah, that is optimesh.