Preface on minimally invasive techniques in spine surgery and trend toward ambulatory surgery
The healthcare climate has undergone a significant shift over the last ten years, with a push towards value of care. This has required physicians to adapt to improve the perioperative recovery of patients undergoing spine surgery. This includes smaller incisions, less blood loss, with earlier mobility to allow for surgeries to be performed in the ambulatory setting (1).
However, the ability to perform spine surgery safety in the outpatient setting is not without its challenges. Over the course of the last 10 years, minimally invasive options have allowed the ability to perform spinal fusions with little blood and damage to the surrounding soft tissue (2). Utilizing techniques such as lateral interbody fusions we can perform primary or adjacent level disease of the spine with the ability of the patient to go home the same day. In addition, endoscopic techniques have evolved that allow for previously larger morbid surgeries to be done outpatient with easier and faster recoveries for patients (3-5). These techniques allow for preservation of the paraspinal musculature, therefore decreasing pain, blood loss, and hospital stay (1-3).
In addition to surgical techniques, patient selection is also essential in determining who would benefit from minimally invasive techniques and who can be performed in an outpatient setting. In this series, we present data on machine learning as well as patient preoperative perception. These factors can be critical in establishing criteria for patients moving to the ambulatory surgery setting.
The papers in this series also discuss the evolution of endoscopic surgery, the utilization of machine learning, robotic surgery, and use of synthetic bone grafts to reduce donor site morbidity. These tools and more have all pushed toward the evolution of safer, cost effective surgery in the outpatient setting.
Acknowledgments
None.
Footnote
Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Spine Surgery, for the series “Minimally Invasive Techniques in Spine Surgery and Trend Toward Ambulatory Surgery”. The article did not undergo external peer review.
Funding: None.
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-2024-03/coif). The series “Minimally Invasive Techniques in Spine Surgery and Trend Toward Ambulatory Surgery” was commissioned by the editorial office without any funding or sponsorship. C.K. served as the unpaid Guest Editor of the series. The author has no other conflicts of interest to declare.
Ethical Statement: The author is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
References
- Rana P, Brennan J, Johnson A, et al. Outcomes and Cost-Effectiveness of Hospital Outpatient Versus Ambulatory Surgery Center Lumbar Decompression Surgery. Global Spine J 2024; Epub ahead of print. [Crossref] [PubMed]
- Skovrlj B, Gilligan J, Cutler HS, et al. Minimally invasive procedures on the lumbar spine. World J Clin Cases 2015;3:1-9. [Crossref] [PubMed]
- Jarebi M, Awaf A, Lefranc M, et al. A matched comparison of outcomes between percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for the treatment of lumbar disc herniation: a 2-year retrospective cohort study. Spine J 2021;21:114-21. [Crossref] [PubMed]
- Heo DH, Lee DC, Kim HS, et al. Clinical Results and Complications of Endoscopic Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Meta-Analysis. World Neurosurg 2021;145:396-404. [Crossref] [PubMed]
- Kim HS, Wu PH, Kim JY, et al. Retrospective Case Control Study: Clinical and Computer Tomographic Fusion and Subsidence Evaluation for Single Level Uniportal Endoscopic Posterolateral Approach Transforaminal Lumbar Interbody Fusion Versus Microscopic Minimally Invasive Transforaminal Interbody Fusion. Global Spine J 2023;13:304-15. [Crossref] [PubMed]
