Wohns Richard
South Sound Neurosurgery, PLLC, 1802 S. Yakima, Tacoma, WA 98405.
Surg Neurol Int. 2010 Dec 13;1:77. doi: 10.4103/2152-7806.73803.
To assess the safety, clinical efficacy, and cost-effectiveness of outpatient cervical disc arthroplasty.
We retrospectively reviewed the records of 26 consecutive patients who underwent outpatient cervical disc arthroplasty between February 2009 and May 2010 in order to assess the safety, clinical efficacy, and cost-effectiveness of the process. Fourteen patients were operated in a -free-standing practice-based ambulatory spine surgery center (MSC) and 12 patients were operated in a hospital-based outpatient surgery center. The mean age of the patient sample was 46 years; 56% were female and 44% were male. Indications for surgery consisted of cervical radiculopathy secondary to single-level soft disc herniation. Charts were reviewed to define patient demographics and medical comorbidities. Operative data, including levels treated, surgery time, time to discharge, and intraoperative complications were collected. Clinical outcomes were collected using the PhDx Clinical Outcomes Database. Need for hospital transfer from the ambulatory surgical center (ASC), emergency room visits, and subsequent hospital admission in the perioperative period were determined from patient records. Complications, patient satisfaction, and outcome were ascertained via review of notes from the first post-operative visit.
There was no mortality and no major complications. Pain was present in 100% and motor deficit in 33% of the patients. There were no co-morbidities reported in the group. There were no cases that required hospital transfer and there were no post-op Emergency Room visits or subsequent hospitalization. At the time of the first post-operative visit, 100% of the patients believed that they were improved and no patient had any post-operative complications. The cost of outpatient single-level cervical disc arthroplasty was 62% less than the outpatient single-level cervical anterior discectomy with fusion using allograft and plate and 84% less than the inpatient single-level cervical disc arthroplasty.
Outpatient cervical disc arthroplasty is safe and clinically efficacious in selected patients and is cost-effective compared with both inpatient cervical disc arthroplasty and outpatient anterior discectomy with fusion.
评估门诊颈椎间盘置换术的安全性、临床疗效及成本效益。
我们回顾性分析了2009年2月至2010年5月期间连续接受门诊颈椎间盘置换术的26例患者的记录，以评估该手术过程的安全性、临床疗效及成本效益。14例患者在独立的基于实践的门诊脊柱手术中心（MSC）接受手术，12例患者在医院的门诊手术中心接受手术。患者样本的平均年龄为46岁；56%为女性，44%为男性。手术适应症为单节段软性椎间盘突出继发的颈椎神经根病。查阅病历以确定患者人口统计学特征和医疗合并症。收集手术数据，包括治疗节段、手术时间、出院时间及术中并发症。使用PhDx临床结果数据库收集临床结果。根据患者记录确定围手术期从门诊手术中心（ASC）转至医院、急诊就诊及随后住院的必要性。通过查阅首次术后访视记录确定并发症、患者满意度及结果。
无死亡病例及重大并发症。100%的患者存在疼痛，33%的患者存在运动功能障碍。该组未报告合并症。无病例需要转至医院，术后无急诊就诊或随后住院情况。在首次术后访视时，100%的患者认为病情有所改善，且无患者出现任何术后并发症。门诊单节段颈椎间盘置换术的费用比使用同种异体骨和钢板的门诊单节段颈椎前路椎间盘切除融合术低62%，比住院单节段颈椎间盘置换术低84%。
对于选定患者，门诊颈椎间盘置换术安全且临床疗效良好，与住院颈椎间盘置换术及门诊前路椎间盘切除融合术相比具有成本效益。
