• World Neurosurg · May 2023

    Feasibility and Safety of Microendoscopic Posterior Cervical Foraminotomy in an Ambulatory Surgery Center: A Longitudinal Experience With 1000 Cases.

    • Steve H Monk, Daniel Zeitouni, David Cowan, Vincent J Rossi, Jonathan M Parish, E Hunter Dyer, Mark D Smith, Paul K Kim, and Tim E Adamson.
    • Atrium Health Neurological Surgery, Charlotte, North Carolina, USA; Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina, USA. Electronic address: Steve.Monk@CNSA.com.
    • World Neurosurg. 2023 May 1; 173: e228e233e228-e233.

    ObjectiveAmbulatory surgery centers (ASCs) have become an increasingly attractive setting for spine surgery in recent decades. Although posterior cervical foraminotomy (PCF) is widely performed in ASCs, there are no studies supporting the safety of this practice. We aimed to demonstrate the feasibility and safety of microendoscopic (MED)-PCF in a large cohort of patients at a freestanding ASC.MethodsConsecutive patients undergoing MED-PCF for unilateral cervical radiculopathy at a single freestanding ASC from January 2013 to December 2020 were queried. Standard demographic and perioperative data were collected. Outcomes included need for inpatient transfer, perioperative complications, 30-day readmission, 30-day reoperation, and clinical improvement according to the Odom criteria.ResultsA total of 1106 patients underwent MED-PCF during the study period. Mean age was 53.3 ± 10.3 years. Most patients underwent decompression at C5-6 (31.4%) or C6-7 (51.9%). Approximately 10% underwent surgery at multiple levels. Mean operative time was 40.0 ± 16.4 minutes. There were no intraoperative or immediate postoperative complications. All patients were discharged home within a few hours of surgery. The rates of 30-day readmission (0.81%) and reoperation (0.36%) were exceedingly low. Nearly 3 quarters of patients (73.7%) achieved a good or excellent clinical outcome (73.7%) according to the Odom criteria.ConclusionsMED-PCF can be performed in a freestanding ASC with exceedingly low rates of perioperative complications and short-term readmission or reoperation. Our findings support the ongoing migration of PCF from the hospital to the ambulatory setting. Future studies assessing patient-reported outcomes and long-term reoperation rates are necessary.Copyright © 2023 Elsevier Inc. All rights reserved.

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