Casey Davidson, M.D., an experienced orthopaedic surgeon specializing in spine procedures, recently completed the first anterior cervical discectomy and fusion (ACDF) at Bone and Joint Institute of Tennessee, a state-of-the-art ambulatory surgery center (ASC) that opened last year outside Nashville, TN.
“It is exciting to be able to do ACDF on an outpatient basis because cervical fusions are significant surgeries and previously, patients would stay in the hospital for a number of days,” Davidson explains. “Today, everything is transitioning towards outpatient procedures. This was a first for us, and hopefully a first of many. This case also involved implanting a cage between the vertebra and marked the first time this particular titanium cage had been used in the United States.”
ACDF involves removing a damaged disc to relieve spinal cord or nerve root pressure, alleviating pain, weakness, numbness, and/or tingling. The surgery is approached through the front of the neck. After disc removal a fusion is done, replacing the disc with a bone graft and/or implant – in this case the titanium cage – to provide stability and strength.
Davidson has performed more than 100 such surgeries in hospitals, but believes this first procedure at Bone and Joint Institute of Tennessee Surgery Center will open the door for more. While some ACDF surgeries involve multiple levels (multiple damaged discs) requiring hospital care, many can be successfully completed at well-prepared ASCs.
“We have some fantastic Anesthesiologists who have a multimodal protocol to allow patients to recover and come out from anesthesia much quicker and in much better shape,” he says. “In addition, it’s about patient selection, technique and instrumentation.”
Several variables help identify the ideal patient for outpatient ACDF. Davidson says the patient in this case was relatively young and healthy with no heart or lung issues or underlying disease processes. She was free of severe arthritis and had no spinal cord compression, just nerve root compression.
“She’s doing great,” he says. “I saw her early last week, and her incision had healed, x-rays were looking good, and her pain had resolved.”
The anterior approach also helps make outpatient ACDF possible. Initially used by eye, nose and throat surgeons, orthopaedic specialists began using it a number of years ago to access the spine.
“It’s actually much less painful and allows for a much quicker recovery than going in the back of the neck,” Davidson says. “The muscles in back are more sensitive, so that can be more painful. We go in the front, moving the breathing tube, trachea, esophagus, and carotid artery out of the way. The key is being careful with the tissues to minimize disruption that would cause swelling.”
Dr. Davidson is excited about the potential to conduct more outpatient spine procedures at Bone and Joint Institute of Tennessee Surgery Center.
“This is a step towards moving a larger percentage of spine procedures over to our surgery center,” he says. “From an orthopaedic standpoint, we’re realizing we can move larger procedures, cervical fusions, maybe even, in the not-too-distant future, lumbar fusions. That’s more aggressive, but we’re trending in that direction.”
To learn more about the Bone and Joint Institute of Tennessee Surgery center click here.