Objective: The use of postoperative drains for elective spine surgery has not been justified. In transitioning to the outpatient setting, there may be concerns for haematoma formation in same day procedures. The purpose of the study is to evaluate the outcomes of lumbar spine surgery with no drains in the outpatient setting compared to the inpatient setting. Methods: The medical records of prospectively collected data for 170 patients who had single-level posterior lumbar interbody fusion (PLIF) were retrospectively reviewed. Two equal cohort groups of 85 patients were assessed, inpatients in which PLIF with drains was performed in the hospital setting, and outpatients with PLIF without drains was performed in the ambulatory surgery centre (ASC).

Objective: Neck pain is a leading cause of disability with an increased prevalence of up to 20% annually in some reports. Various studies have shown improvements in symptoms and quality of life in patients who underwent anterior cervical discectomy and fusion (ACDF) for symptomatic nerve root compression and spondylosis. With the increased prevalence of these aforementioned conditions, it is imperative to understand the national trends in the use of ACDF. The authors aim to report on the incidence of ACDF in the United States of America (USA) over a four-year period and the associated procedural reimbursement costs. Methods: A query was performed for patients who underwent ACDF using the PearlDiver supercomputer (Warsaw, IN) from 2011 to 2014. Patients were identified by current procedural terminology (CPT) Codes 22551 and 22552 and their demographics, location of surgery and reimbursement costs were later analysed. Results: Our query returned a total of 13 143 ACDFs over the four-year study period of 2011 to 2014. The total number of procedures done in the outpatient setting increased significantly from 454

Objective: Dysphagia is a relatively common occurrence in the postoperative period following anterior cervical surgery, with some indicating rates as high as 79%. In most cases, it remains only a transient phenomenon. The cause has been debated, with most speculating injury to nerves in the swallowing mechanism. The objective of this study was to determine if the presence of instrumentation during anterior cervical surgery in the outpatient setting would affect the incidence, duration and severity of dysphagia. Methods: We did a retrospective review of the medical records of 50 consecutive patients who had undergone single-level instrumented anterior cervical discectomy and fusion. Then we compared that group with our control group of 50 patients who had had simple single-level anterior cervical discectomy without instrumentation or fusion. The patients were evaluated for the presence of dysphagia as well as neck disability index outcome scores. Results: There was no significant difference between the groups in postoperative neck disability index outcomes at the two-year follow-up (p = 0.182). Dysphagia occurred only in the instrumented group, with an incidence of 12% (six patients): their symptoms lasted on average three weeks, and all six patients experienced only mild severity on the Bazaz-Yoo scale. There was statistically significant difference between the two groups (p = 0.012). Conclusion: There was a greater trend towards postoperative dysphagia in cases with instrumentation (12% of the patients). Dysphagia was transient with mild severity in patients who received instrumentation compared with those who underwent discectomy alone.

Experiencia y ventajas del uso de orificios pretaladrados para los tornillos antes de colocar las placas a 330 pacientes consecutivos durante una Discectomía y Fusión Cervical Anterior RESUMEN Objetivo: El uso de orificios pretaladrados para colocar y fijar con precisión placas cervicales anteriores (PCA) no está establecido en la literatura. A pesar de la utilidad de la PCA después de una discectomía y fusión cervical anterior (DFCA), persisten los retos con respecto a su exacta colocación y alineación, que podrían interferir y afectar el nivel adyacente. Los autores describen una

Objective: Surgical site infection (SSI) is a well-documented cause of patient morbidity, with an associated increase in cost to the healthcare system. The move to outpatient surgery is to reduce the overall cost of surgery in conjunction with improved patient morbidity. The authors aim to determine the incidence of SSIs in the outpatient setting and associated risk factors. This information will prove to be invaluable to overall patient care. Methods: The databases of 2205 spinal procedures performed over 10 years by a single surgeon were reviewed. Two groups were created; Group 1 patients with procedures performed in the hospital setting and Group 2 patients with procedures performed in the ambulatory surgery centre. Excluded cases were patients under 18 years old, acute trauma and minor orthopaedic procedures. Included cases were cervical fusions, disc replacement and lumbar decompressions with or without fusion. Outcomes assessed included; age, body mass index (BMI), surgeon time and estimated blood loss (EBL). Relative risk factors such as BMI, smoking, alcohol use and a number of spinal levels operated on were also assessed as independent risk factors for SSIs.