Only in recent years have surgeons offered outpatient lumbar spinal fusions.
By use of modern localization techniques and muscle-splitting dissections, the postoperative incisional pain can be tolerated enough to allow an outpatient process.
In the past 15 years, advances in spine surgery instrumentation have yielded a tremendous selection of percutaneously delivered spine screws, cages, and exposure retractors. These instruments are designed to create a lumbar spine fusion construct that can be delivered using small incisions and muscle-splitting dissections.
The prudent surgeon, however, will be careful to offer outpatient spinal fusion only with the correct indications, overall health, body type, and pain tolerance. While the procedure can be done successfully using these minimally invasive techniques, other factors may determine the appropriateness of an outpatient setting for certain patients.
Specific types of fusion that may be done by an appropriately skilled and experienced surgeon include:
Anterior Lumbar Interbody Fusion (ALIF)
Some surgeons are able to do an ALIF on an outpatient basis. This is largely because an ALIF includes an approach from the front, through the abdomen, so there is minimal tissue disruption.
Lateral Lumbar Interbody Fusion (e.g. a TLIF or XLIF)
Similar to an ALIF, a fusion approach from the side can be done with minimal tissue disruption, allowing the procedure to be done on an outpatient basis in a properly selected patient and with an appropriately experienced surgeon.
As far as lumbar fusions are concerned, at this time, only a small percentage of the patient population will be appropriate candidates for an outpatient experience.8
- Chin KR, Coombs AV, Seale JA. Feasibility and patient-reported outcomes after outpatient single-level instrumented posterior lumbar interbody fusion in a surgery center: preliminary results in 16 patients. Spine. 2015;1:40(1);E36-42.