Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced Recovery after Surgery (ERAS): Early Experience with Initial Consecutive Cases at a Spine Naïve Community Hospital

Objective: The objective of this study was to examine a spine naïve community hospital’s ability perform MITLIF safely and with speedy discharge via implementation minimally invasive surgery (MISS) program utilizing ERAS. Methods: Single hospital retrospective cohort analysis for initial consecutive cases unilateral pedicle screws performed by single surgeon from October 2019 March 2021. Minimum postoperative follow-up one year. Narcotic use assessed per the state prescription drug monitoring program. Surgery protocol included paraspinal incision, non-expandable 18/22 mm tube, operating microscope, fluoroscopic guidance, EMG SSEP Enhanced Recovery After (ERAS) protocol. Results: 52 patients were included. Average OR time, fluoroscopy time 143±115 minutes, 1.00±0.47 respectively. Patients prescribed an average 38±33 post-operative opioid doses 8±7 days. All on preoperative, chronic narcotics had no changes, pre-op versus post-op, despite clinical improvement. Complications irrigation a(1.9%) nd debridement retention hardware surgical site infection, revision(1.9%) displaced hardware. Discharge data 47 (90.4%), four (7.7%), (1.9%) discharged POD1, POD2, beyond respectively.Conclusion: can be successfully at excellent intraoperative metrics, low complication rate, discharge. well in multiple perioperative variables compared MISS techniques. Considerations setting include special equipment, personnel training, experience, ERAS protocols diligent patient/indication selection.