Bani Aram A, Köhlert Katharina, Zelenka Marek
Dr. Bani and Colleagues, Ambulatory Spine Center, Kreuzensteinstr. 9, D-78224, Singen am Hohentwiel, Germany.
, In den Weihermatten 6, D-79108, Freiburg, Germany.
Eur Spine J. 2025 Aug 14. doi: 10.1007/s00586-025-09257-2.
This study aims to determine the feasibility of outpatient neurosurgery, which modern microsurgery enables through minimally invasive, tissue-sparing, and low-risk spinal procedures. Outpatient care offers several advantages, including rapid return to the home environment, avoidance of hospital-acquired infections and multi-resistant germs, significant cost savings, and increased patient satisfaction.
Between October 2023 and May 2025, a total of 555 patients underwent surgery at our outpatient neurosurgical center. The procedures performed included; Lumbar spinal canal decompression: 287 cases (51.7%), Microdiscectomy for lumbar disc herniation: 124 cases (22.3%), Extradural tumor resection: 53 cases (9.5%), Removal of spinal implants: 37 cases (6.7%), Cervical posterior foraminotomy 18 cases (3.2%), Spinal cord stimulation (implantation): 16 cases (2.9%), Percutaneous balloon kyphoplasty: 7 cases (1.3%), Sacral Tarlov cyst fenestration or occlusion: 7 cases (1.3%), Baclofen or morphine pump implantation: 6 cases (1.1%). Each patient was monitored for three to four hours in the recovery area following surgery. Discharge was approved once the patient was fully mobilized and had voided spontaneously. Notably, no surgical drains were used in any of the cases. The age of patients ranged from 15 to 88 years. Gender distribution was 46% male and 54% female. According to the American Society of Anesthesiologists (ASA) physical status classification, 32% of patients were categorized as ASA I, 59% as ASA II 32% and 9% as ASA III.
Home care was clarified in advance. There were 5 Cases (1.2%) of postoperative secondary haemorrhages within the first four hours which were revised immediately with complete recovery. In 32 (5,7%) patients, the dura was accidentally injured, of which three patients required revision with a delay due to a symptomatic cerebrospinal fluid collection. Three patients experienced a deterioration of neurological status after the dural injury, of whom two improved completely within 8 weeks and through inpatient treatment. There were three cases of wound dehiscence which were treated conservatively and 17 (3,0%) Cases with superficial wound infection. One patient deteriorated directly after intubation before starting the operation and passed away two days later of cardiopulmonary failure.
Ambulatory care for uncomplicated lumbar spine conditions is feasible, safe, and effective. It saves significant costs, increases patient satisfaction, and relieves the burden on large hospitals. In particular, patient waiting times for surgery were reduced.
本研究旨在确定门诊神经外科手术的可行性，现代显微外科手术通过微创、保留组织和低风险的脊柱手术实现了门诊神经外科手术。门诊护理具有诸多优势，包括迅速返回家庭环境、避免医院获得性感染和多重耐药菌、显著节省成本以及提高患者满意度。
在2023年10月至2025年5月期间，共有555例患者在我们的门诊神经外科中心接受手术。所进行的手术包括：腰椎管减压术：287例（51.7%），腰椎间盘突出症显微椎间盘切除术：124例（22.3%），硬膜外肿瘤切除术：53例（9.5%），取出脊柱植入物：37例（6.7%），颈椎后路椎间孔切开术18例（3.2%），脊髓刺激（植入）：16例（2.9%），经皮球囊椎体后凸成形术：7例（1.3%），骶骨塔尔洛夫囊肿开窗或闭塞术：7例（1.3%），巴氯芬或吗啡泵植入术：6例（1.1%）。术后，每位患者在恢复区接受三到四个小时的监测。一旦患者能够完全活动并自主排尿，即可批准出院。值得注意的是，所有病例均未使用手术引流管。患者年龄在15岁至88岁之间。性别分布为男性46%，女性54%。根据美国麻醉医师协会（ASA）身体状况分类，32%的患者被归类为ASA I级，59%为ASA II级，9%为ASA III级。
提前明确了家庭护理。有5例（1.2%）患者在术后前四个小时内发生继发性出血，立即进行了修正，患者完全康复。在32例（5.7%）患者中，硬脊膜意外受损，其中3例患者因有症状的脑脊液积聚而需要延迟修正。3例患者在硬脊膜损伤后神经功能状态恶化，其中2例在8周内通过住院治疗完全恢复。有3例伤口裂开，采用保守治疗，17例（3.0%）患者发生浅表伤口感染。1例患者在手术开始前插管后直接病情恶化，两天后因心肺衰竭死亡。
对无并发症的腰椎疾病进行门诊护理是可行、安全且有效的。它节省了大量成本，提高了患者满意度，并减轻了大型医院的负担。特别是，减少了患者的手术等待时间。
