All posts by Legacy Neurosurgery

MIGLIF Abstract

Retrospective Review of an MIS Lumbar Fusion Technique in Outpatient and Hospital Settings

Scott Schlesinger, M.D. (Legacy Neurosurgery and Spine, Little Rock, AR)


Introduction:  Advances in MIS surgery have helped expand the number of procedures that may be performed safely on an outpatient basis.  Patients may benefit from decreased tissue disruption that potentially minimizes pain, blood loss, complications, hospital stay, and recovery time.   Our clinic has combined MIS techniques with image guided navigation to develop a lumbar fusion procedure that can be performed through a single midline incision with cortical screw trajectory, achieving direct decompression, fusion, and instrumentation, permitting patients with low comorbidities to be treated on an outpatient basis.  Here we compare surgical results from outpatient and hospital settings.


Methods:  Under IRB approval, a retrospective chart review of a consecutive series of adults with lumbar stenosis and instability, treated over an 11-month period by one surgeon, was performed.  Charts were reviewed for demographics, diagnosis, medical history, surgical parameters, and complications.


Results: A total of 73 patients with degenerative disease positive for radicular pain and segmental instability were reviewed (Table 1).  Outpatients (n=40) were single level procedures, while hospital patients (n=33) were treated at one (n=28) or two levels (n=5).  Average OR time was 204±51 minutes for outpatients and 221±61 for hospital patients (Table 2).  Average estimated blood loss was 345cc±198 for outpatients and 298cc±217 for hospital patients.  All surgical incisions were <2cm and no blood transfusions were required.  All outpatients were successfully discharged on the same day.  Average stay for hospital patients was 2.5±2.6 days.  There were no unanticipated complications or trends observed.


Conclusion:  Surgical outcomes in this series demonstrate the initial benefits of the midline technique in outpatient or hospital settings.  Navigation, cortical bone trajectory, and keyhole incision allows direct decompression and instrumentation, optimizing MIS in the lumbar spine.  Long-term, prospective clinical studies may further demonstrate the safety and long-term efficacy of this technique.


Table 1.  Patient Demographics                                                                                                 

Outpatient (n=40) Hospital




Age 52.1 ± 8.6 62.4 ± 17.0 56.8 ± 14.0
Sex 24 Males

16 Females

15 Males

18 Females

39 Males

34 Females

Prior Surgery   (any lumbar level) 15 Yes (38%)

25 No

15 Yes (45%)

18 No

30 Yes (41%)

43 No

Levels Treated All single levels 28 single level

5 two-level

68 single level

5 two-level


 Table 2. Surgical Parameters and Intra-Operative Complications

Outpatient (n=40) Hospital (n=33) Total (n=73)
Surgical Parameters
·   OR Time (Minutes) 204 ± 51 221 ± 61 212 ± 56
·   Est. Blood Loss (CC) 345 ± 198 298 ± 217 324 ± 206
·   Hospital Stay (days) Same Day 2.5 ± 2.6 1.1 ± 2.1
Intra-Op Complications (n)
·   Intra-Op Durotomy 2 3 5
·   Dural Fistula 1 0 1
·   Cardiac Issue 0 1 1
·   Urinary Stasis 1 1 2
·   Psuedomemingocele Repair

       (From prior fusion surgery)

0 1 1

Submitted to the 2017 Annual Meeting of the Congress of Neurological Surgeons, to be held October 7-11, 2017 (Boston, MA)

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back pain

5 Bad Habits You Don’t Know Are Causing You Back Pain

You hear about the typical reasons for back pain all the time; a slipped disc, a work injury, a genetic disorder. But you may not know all the things you do on a daily basis that indicate you’re headed towards a whole heap of pain. Back pain often isn’t an instantaneous thing. It usually occurs as a culmination of things that have happened to your body over the years. So, we’ve put together the top five bad habits that you might not even know are contributing to your pain or might contribute to pain in the future.

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National Yoga Day Stretches to Ease Back Pain

Whether young or old, male or female, chances are you’ll experience back pain at some point in your life. Whether you drink hot tea or sweet iced tea, whether you’re a world traveler or homebody, chances are an injury, poor posture, or aging will affect the way you sympathize with chronic back pain sufferers. We have the expertise, staff, and passion for treating back pain for every walk of life, but there are things our patients can do at home – like yoga – to help prevent or help alleviate inflammation.

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How To Avoid Migraines During the Holidays

Migraines always seem to strike at inopportune times. And with the countless holiday parties, gatherings and trips that will be going on in the next month, the number of events that could be effectively ruined by an ill-timed migraine are about to greatly increase. Unfortunately, along with the number of events that could be ruined by migraines, the amount of migraine triggers is also about to go up. Indulgent food, bright décor and unusual schedules can all heighten the chance of migraines, yet avoiding these throughout the next month seems near impossible. By following the below guidelines, you can increase your chances of enjoying your typical holiday merriment while also keeping headaches and migraines in check.

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Holiday travel

Protect Your Back During Holiday Travel

Holiday season is officially here, and for many central Arkansans, that means lots of travel hours spent in the car and airport to see far away friends and family. Grueling holiday travel can be taxing on the healthiest people, but for those with chronic back pain, it can be almost unbearable. Below, we’ve outlined a few basic practices to help you have a happy, pain-free holiday.

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What Legacy Is Thankful For

As in the case with most of us, it’s easy to get caught up in the daily routine of life. A pop-tart on the way to work. Lunch at your desk. Picking up kids at soccer practice. Attempting to clean the house before it gets destroyed again by the new puppy. Rarely, do we all have a moment to sit, breathe, and take in this amazing life we are so honored to live.

When you are suffering from back pain, it gets even harder to shift that focus to thankfulness. So, we are taking this time to allow our amazing Legacy staff to remind us about the important things in life that keep them thankful all year long.

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smoking and back pain

The Rocky Relationship Between Smoking and Back Pain

It’s not new news necessarily, but even more research has come out to back it up. Smoking is directly linked to your back pain. Scientists from Northwestern University in Evanston, Illinois released information through a study that suggested that smoking directly interferes with a circuit in two different regions of your brain that is associated with pain.

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prevent back pain

Prevent Back Pain on Plane Rides

Holiday season is quickly approaching and some of our patients are booking their flights to go home to see family they don’t get to see any other part of the year. We love to see their excitement. But hate to see the anxiety that ultimately sets in when they think of the low back pain they experience when sitting for a long period of time.

By the very nature of the word “vacation”, a person should experience the act of vacating their normal routine; including dealing with chronic back pain. So we’ve put together an action list for those flying to family and friends this season to help them prevent back pain on plane rides.

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