First-generation artificial discs resembled nothing more than a mar-
ble between 2 plates. Designs have progressed to a sliding bearing
between 2 metal plates that mimic the motion of native discs — 5
degrees of flexion, extension, side bending and rotation — but can
cause hyperflexibility of vertebral joints.
Dr. Blythe says the newer generation of artificial discs are designed
with nano fibers woven in a ring around a soft cushion center to
mimic more of a native's disc structure, making them easy to use and
best to achieve reproduceable results and good outcomes in the cervi-
cal spine and possibly in the lumbar spine.
Backbone of future growth
Few would argue the merits of providing quality and cost-effective
care with good patient experiences, but the question remains: How do
you do it right?
Matt McGirt, MD, a minimally invasive spine surgeon in Charlotte,
N.C., says 1- or 2-level lumbar discectomy, minimally invasive laminec-
tomies, 1-level open or multilevel laparoscopic lumbar decompressive
procedures can be done effectively and safely in the outpatient set-
ting. "We know those procedures don't require more than four hours
of observation and recovery in an ASC," he says.
Dr. McGirt says there's growing evidence that 1- and 2-level anterior
cervical discectomy and fusion (ACDF), and anterior cervical discec-
tomy and fusion can also be done very effectively and safely without
hospitalizing patients for post-op observation. He also points out mini-
mally invasive transforaminal lumbar interbody fusion (TLIF) is begin-
ning to emerge as an outpatient option.
Talking about the procedures that can be done in the outpatient set-
ting is only part of the conversation providers should be having,
according to Dr. McGirt. "Equally important is asking what proce-
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