Rapid (enhanced) recovery for fusion surgery in the degenerative spine: Clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up

Introduction

Spinal surgical procedures became very frequent in the last decades with fusion techniques being widely used for several indications. Many of these surgeries imply a significant tissue disruption and muscle atrophy with subsequent pain and functional impairment.

Research question

How to prepare and manage patients according to a rapid/enhanced recovery (RR/ERAS) protocol in a private setting while improving patient’s peri-operative experience and minimizing surgical footprint?

Material and methods

All patients suffering from a thoracolumbar degenerative disease and with an indication for fusion between January 2018 and October 2021 were screened. Pain control, functional recovery, complication rate and patient’ satisfaction were recorded for at least one-year of follow-up (FU).

Results

100 patients were prospectively followed for at least one year after surgery. More than two thirds (n = 69, 69.0 %) had a trans-psoas extreme lateral interbody fusion (X-LIF) or anterior approach with posterior instrumentation and direct decompression when needed, 14 (14.0 %) had an anterior lumbar interbody fusion (ALIF) and 17 (17.0 %) patients had a posterior approach only (posterior LIF or transforaminal LIF). Most patients had multi-level surgery (n = 56, 56.0 %). All patients improved their quality of life and back and leg pain at one year FU with those having an antero-lateral approach improving significantly more. Overall satisfaction rate was higher than 90 %.

Discussion and Conclusion

The application of RR/ERAS protocols to fusion surgery in degenerative spine proves to feasible and beneficial in a private care setting. Patients having anterolateral approaches tend to improve more than those with posterior only approaches.