Saturday, September 29, 2018 9:00 am–10:00 am A Fresh Look at Opioids: 273. Enhanced recovery approach for minimally invasive transforaminal lumbar interbody fusion (TLIF): a single institution comparison of outcomes

Abstract

BACKGROUND CONTEXT Enhanced recovery after surgery (ERAS) protocols were developed to alleviate the stress response following surgery, thus promoting recovery. Although widely accepted in other specialties, “fast track” surgical approaches are not currently implemented in spine surgery. In this abstract, we tailored some of these principles to minimally invasive spine surgery for the first time. PURPOSE We developed the first enhanced recovery protocol for a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) with ultra-minimal tissue disruption, non-narcotic pain management and early aggressive mobilization to assess its validity in the context of enhanced recovery tenets. METHODS A retrospective review of 94 consecutive patients underwent lumbar fusion with endoscopic decompression, expandable cage, percutaneous pedicle screws, and long-acting depoform bupivacaine under conscious sedation. The comparison cohort of 81 patients underwent a similar procedure under general endotracheal anesthesia (GA) without the use of an endoscope. RESULTS Groups were not statistically different for age (p=.028), gender (p=.12) and six-month fusion rates (100%). Length of stay (median 0 days vs. 4 days; p CONCLUSIONS Although endoscopy has aided in lesser tissue disruption, reduced EBL and operative time, several other factors seemed to play a substantial role towards fast track recovery, resulting in sedation patients experiencing less hypotension, receiving fewer vasopressors, fluids, and opioids, and demonstrating reduced length of stay. This is the largest series to date using ERAS principles for spine surgery. FDA DEVICE/DRUG STATUS Working channel endoscope (approved for this indication), anesthesia without intubation (approved for this indication), expandable cage (Not approved for this indication), BMP (not approved for this indication), small caliber percutaneous screws (approved for this indication), liposomal bupivacaine (not approved for this indication).