Return-to-Duty Rates Following Minimally Invasive Spine Surgery Performed on Active Duty Military Patients in an Ambulatory Surgery Center.

BACKGROUND: Low back pain is a primary health care utilization driver in the US population. Health care evaluation visits for low back pain are as common as medical evaluation for the common cold. Low back pain is the most common reason for reductions in activities of daily living and work activity in the general population. Although these statistics are compelling, in the military population, there is arguably a significantly greater economic impact on the military population, as the cost to train, retain, and deploy a service member is a tremendous cost. METHODS: The current study retrospectively examines surgical outcomes, return to duty, and patient-centric outcomes among 82 active duty or reserve military patients who underwent an outpatient minimally invasive spine surgery Laminotomy Foraminotomy Decompression for the treatment of lumbar spinal stenosis in an ambulatory surgery center. FINDINGS: Overall, our results indicate that within the 82 active duty military service members, 100% of the service members return to duty within 3 mo. Additionally, there was a significant reduction in self-reported pain and disability 12 mo postoperative, whereas the average length of surgery was 62 min with an average estimated blood loss of 30.64 mL. DISCUSSION: The current study indicates that minimally invasive procedures for the treatment of lumbar spinal stenosis in an ambulatory surgery center setting are an effective option for active duty servicemen to reduce return-to-duty rates and symptomatic back-related pain and disability.

A Novel Targeted Foraminoplasty Device Improves the Efficacy and Safety of Foraminoplasty in Percutaneous Endoscopic Lumbar Discectomy: Preliminary Clinical Application of 70 Cases.

OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) has become a mature and mainstream surgical technique for treating lumbar disc herniation (LDH); however, there is a steep learning curve with PELD, especially for puncture and foraminoplasty. In this study, we assessed the outcome and safety of a novel quantificational and targeted foraminoplasty device named ZESSYS for LDH. METHODS: From September to December of 2016, 70 patients with symptomatic LDH were enrolled in the study. The patients were assigned randomly to either the ZESSYS group or the conventional TESSYS group. We recorded the cannula introduction time, decompression time, radiation exposure time, intraoperative pain feeling score, visual analog scale, Oswestry Disability Index, and Macnab criteria score of the 2 groups. The mean follow-up period was 14 months. RESULTS: The average cannula introduction time (16.50 ± 3.29 minutes) and the radiation exposure time (40.71 ± 6.23 seconds) in the ZESSYS group were significantly reduced compared with the TESSYS group (cannula introduction time, 20.06 ± 3.37 minutes, P = 0.000; radiation exposure time, 49.20 ± 7.84 seconds, P = 0.000). Intraoperative pain feeling score in the ZESSYS group was significantly improved compared with the TESSYS group (P = 0.021). There were no significant differences between the 2 groups for decompression time (P = 0.617), Macnab criteria (P = 0.769), or visual analog scale and Oswestry Disability Index scores at the same time point (P > 0.05). No serious complication was observed in any patients in either group. CONCLUSIONS: The novel targeted foraminoplasty technique with the specially designed double-cannulas is an effective and safe treatment for lumbar intervertebral disc herniation. It reduces the difficulty of PELD learning, minimizes radiation exposure, and decreases intraoperative pain associated with foraminoplasty.