Safety and reproducibility of Total Cervical Disc Replacement in an Ambuatory Surgery Center

Nitin Khanna MD, FAAOSMichael Krzyskowski PA

www.nkspine.com

History of Spine Surgery

� Long procedures with high complication rate- “Don’t let anyone operate on your spine”

� Advanced technology and goal to improve outcomes with shorter recovery periods – key US surgeons leading minimally invasive spine surgery.

� Key concept – God built the patient better than I can fix them

Cervical Disc Replacement

� Replace cervical discs instead of fusing – Largest experiences in the Region

What are we doing now – Why?

● Most Surgeons still use over top cervical plates

● Adjacent segment disease and potential for constriction of the esophagus are at higher risk

● Compare to zero-profile ACDF

Case Example

● 50 year old male ○ 3 months neck

pain, arm pain and weakness

2 weeks postop

● Same day stay in hospital○ Taking 1 Norco every 6

hours● Arm pain resolved - neck

soreness● Soft collar for 2 weeks only● Released to work without

restrictions at 2 weeks

Patient Selection

� Must ensure that the patient is motivated to improve – the best surgery in the wrong patient will not work

� Focus on one level and ensure the other segments are in excellent condition

Methods

� Single surgeon, single center

� Retrospective Chart review� 16 one-level disc replacement, 2 two-level replacements

� 18 consecutive patients� Demographics

� Age, sex, BMI, third party payer

� PACU time

� Comorbidities

� 30 day readmission, infection, blood transfusion

Results

� Demographics� Average age 45.6 (33-57)� 12 male, 6 female� Average BMI 30.0 (23.0-43.1)� 12 private insurance, 6 worker’s compensation

� Comorbidities:� HTN (8), GERD (5), ex-smoker (5), hypothyroidism (4), smoker

(2)� 7 w/ sole comorbidity of: leukemia, h/o esophageal cancer, h/o heart

murmur, h/o hepatitis C infection, glaucoma, arthiritis, diabetes� Average length of stay - 93.9 minutes (54-133)� No infections were noted, no patients required a blood

transfusion or 30-day readmit

Conclusions

� Based on our small data set –Cervical Disc Replacement is safe and reliable procedure in the ambulatory surgery center setting

� Further multicenter studies need to be performed to confirm that this a generalizable findings as all the cases were performed by the senior author

� Patient selection and excellent workflow across disciplines in the Ambulatory surgery center are key to reproducible and safe results.

May 2019 -

� Disc replacement length of stay < 1 day

� No significant difference:� Readmit rate� perioperative adverse � events

� Single level TDR is safe in the outpatient setting

Thank you

Thank you

Questions?

Nitin Khanna, MDMichael Krzyskowski, PA-Cwww.nkspine.comwww.osni.org