Outpatient laminotomy and discectomy.

This is a prospective study of 61 consecutive patients undergoing lumbar laminotomy and discectomy on an outpatient basis. The purpose of this study was to report on the feasibility of performing lumbar laminotomy and discectomy as an outpatient procedure and to assess perioperative complications, patient satisfaction, cost, and clinical results. Conventional lumbar laminotomy and discectomy traditionally requires a 1-3-day hospital stay. Recent advances in anesthesia and surgical techniques, as well as observation of patient progress after this procedure, has led the authors to believe that that this procedure may be performed on an outpatient basis without compromising patient satisfaction, outcome, or complications. Sixty-one consecutive patients underwent surgery for herniated nucleus pulposus in the lumbar spine. The procedure was performed under loupe magnification without the use of a microscope. Clinical outcome and patient satisfaction were assessed at an average follow-up of 12.5 months. The results showed 62% excellent, 31% good, 7% fair, and there were no reports of a poor outcome. During the time of the study, four patients (7%) were admitted to the hospital after the procedure for reasons of pain control, inability to void, or lack of caregiver at home. Overall cost savings were reflected in the cost of inpatient stay when compared to a representative group of inpatients. Laminotomy and discectomy for a hemiated nucleus pulposus has 93% good or excellent results as shown by this study and previous studies. Laminotomy and discectomy, which remains the gold-standard procedure for herniated disc surgery, can be performed safely and effectively as an outpatient procedure in the majority of patients.