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Outpatient Spine Surgery: Safe, Effective and Cost Efficient

By: Ara Deukmedjian, MD Deuk Spine Institute

Spinal surgery is performed to correct abnormalities of the vertebrae, inter-vertebral discs, spinal ligaments, nerves, and spinal cord. Traditionally, spinal surgery has been performed in hospitals by neurosurgeons and orthopedic surgeons. Recent advances in outpatient anesthesia combined with new surgical techniques for minimally invasive spinal surgery and technological advances in operating room equipment mean that many of these surgical procedures are now being performed safely in outpatient centers throughout the country and world.[1-11] Peer reviewed literature provides ample evidence for performing many types of spinal surgery in the outpatient arena with lower complication rates and higher patient and payer satisfaction. [12, 13] At the forefront of spinal surgery, Deuk Spine Institute has safely performed the most common types of spine surgery as outpatient procedures with minimal post-operative discomfort. We would like to offer your organization the opportunity to partner with us to provide “cutting edge” comprehensive spine care to your beneficiaries at our facilities with guaranteed lower cost to you and higher patient satisfaction.

Deuk Spine Institute is a “State of the Art” facility created for the sole purpose of providing the most advanced treatment to date in the world for diseases of the spine. The latest technological advances are available at Deuk Spine Institute including outpatient endoscopic and laser spinal surgery. Most of our spinal surgeries can be performed thru incisions smaller than the diameter of a dime. No hospitalization is needed. Patients are discharged home 30-60 minutes after their surgery. You may return to light duty work as soon as the day after your surgery. Endoscopic spinal surgery is the most successful and least damaging spinal surgery available in the world. The lasers used during surgery are accurate to 1⁄2 mm. Over 90% of our procedures result in 90% relief of pain originating from the spine. There is no surgery or treatment offered elsewhere more successful. Your members deserve to have the best medical care available. Our world class staff of spine experts includes neurosurgeons, neurologists, physiatrists and interventional pain specialists. Dr. Deukmedjian has personally performed over 2,000 cervical decompressive discectomies and treated over 1,000 herniated or degenerated lumbar discs with no major complications.

The Deuk Spine Institute is a Florida state certified office based surgery center credentialed to perform surgical procedures under general anesthesia. All of our surgeries are performed under the direct supervision of medical doctor anesthesiologists. The two operating rooms are fully equipped with the latest, most advanced surgical equipment including high definition Linvatec video endoscopy, Siemens Arcadis Avantic fluoroscope, carbon fiber spinal operating tables, video integration system, medical gasses, Zeiss NC-4 operating microscope, and Atlas monitors. Procedures that are performed on an outpatient basis include cervical and lumbar “laser disc repair” (Deuk Laser Disc RepairTM) decompressive discectomy, instrumented fusion, kyphoplasty for fracture, joint injection, epidurals, nerve block, rhizotomy and spinal cord stimulators and pumps. All patients receive testing and medical clearance before surgery. Complex spinal surgeries are performed by board certified spinal neurosurgeons. Deuk Spine Institute performed its first procedure in April 2008. To date there have been over 2,000 surgeries and procedures performed with no complications and no hospital admissions. Patient safety is our #1, #2 and #3 goals.

Spinal disorders including back and neck pain with or without associated arm and leg pain are very common. Back pain is the #2 reason for doctor’s visits in the USA and accounts for 200 million person days of lost work each year. One in four U.S. adults will suffer with back pain in any given 3 month period.[14] The number of U.S. adults suffering from musculoskeletal disorders continues to grow with annual costs for bone and joint health in the USA soaring at $850 billion. Musculoskeletal medicine is the leading cause of disability in the US with “back” symptoms as the leading cause of job-related disability. Patients with back pain incur substantially higher (> 50%) health care costs than individuals without back pain.

There are many concerns regarding overtreatment of back and neck pain. Improper treatment of back and neck pain by under qualified physicians is very common and leads to unnecessary testing and treatment. Delays in providing definitive treatments by qualified physicians are common for this reason. These delays in definitive treatment of back or neck pain result in unnecessary suffering and “sick” days, diminished productivity of employees, overprescribing of medication and ineffective treatment and out of control costs for all stakeholders. Employees on pain killers at work are more prone to making bad business decisions because of the effects of the medication they are taking for extended periods of time. Poor employee cognitive performance from chronic pain medication abuse or the nagging distraction of chronic back or neck pain may lead to impaired productivity of an employee. There are definitive treatments available now for neck and back pain that give patients their best chance of regaining a normal life without the dependency on painkillers. The patients of Deuk Spine Institute commonly experience immediate, durable pain relief with our laser procedures.

There are 4 basic strategies that have the potential to effectively treat back or neck pain with associated arm or leg pain. They are therapy, medication, injections and surgery. Which treatment we select for a patient depends on the source of their pain. The first step in successfully treating back or neck pain is making the right diagnosis as to the cause of pain. This is usually the hardest step for physicians treating these conditions. It is common for a patient to have more than one cause of pain. The physicians at Deuk Spine Institute stand out in their ability to accurately diagnose and treat all causes of spine and joint pain. Once diagnosed, the correct treatment will be selected. The next step is to educate our patient on the diagnosis and treatment process to facilitate their active participation in their recovery. The third step is to skillfully perform the required treatment. Unfortunately, many doctors fail at these basic steps and the results can be catastrophic for the patient. Making the wrong diagnosis or providing outdated, ineffective or inappropriate treatment will most likely result in a failed attempt to treat the root cause of a person’s pain. It is surprising to see how many patients come to our center every week that have had an unsuccessful procedure performed by another surgeon for this very reason. Failure to diagnose and failure to treat are common problems when treating back and neck pain and frequently lead to unnecessary procedures and prolonged suffering for the patient. At Deuk Spine Institute our success lies in our commitment to provide you with the highest quality medical care by using only the best treatments combined with our world class training. Our success rates are 95% because we offer state of the art treatment by the most capable specialists in the profession of curing neck pain, back pain and sciatica.

1.    An, H.S., J.M. Simpson, and R. Stein, Outpatient laminotomy and discectomy. J Spinal Disord, 1999. 12(3): p. 192-6.
2.    Liu, J.T., R.P. Briner, and J.A. Friedman, Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series. BMC Surg, 2009. 9: p. 3.
3.    Lewis, P.J., et al., Outpatient cervical spine surgery. J Neurosurg, 1998. 88(2): p. 358-9. 4.    Best, N.M. and R.C. Sasso, Outpatient lumbar spine decompression in 233 patients 65 years of
age or older. Spine, 2007. 32(10): p. 1135-9; discussion 1140. 5.    Chiu, J.C., Endoscopic assisted lumbar microdecompressive spinal surgery with a new SMART
endoscopic spine system. Surg Technol Int, 2006. 15: p. 234-41. 6.    Gray, D.T., et al., Population-based trends in volumes and rates of ambulatory lumbar spine
surgery. Spine, 2006. 31(17): p. 1957-63; discussion 1964. 7.    Best, N.M. and R.C. Sasso, Success and safety in outpatient microlumbar discectomy. J Spinal
Disord Tech, 2006. 19(5): p. 334-7. 8.    Stieber, J.R., et al., Anterior cervical decompression and fusion with plate fixation as an
outpatient procedure. Spine J, 2005. 5(5): p. 503-7. 9.    Palmer, S., R. Turner, and R. Palmer, Bilateral decompressive surgery in lumbar spinal stenosis
associated with spondylolisthesis: unilateral approach and use of a microscope and tubular
retractor system. Neurosurg Focus, 2002. 13(1): p. E4. 10.    Palmer, S., Use of a tubular retractor system in microscopic lumbar discectomy: 1 year
prospective results in 135 patients. Neurosurg Focus, 2002. 13(2): p. E5. 11.    Choy, D.S., Percutaneous laser disc decompression: a 17-year experience. Photomed Laser Surg,
2004. 22(5): p. 407-10. 12.    Hersht, M., E.M. Massicotte, and M. Bernstein, Patient satisfaction with outpatient lumbar
microsurgical discectomy: a qualitative study. Can J Surg, 2007. 50(6): p. 445-9. 13.    Zahrawi, F., Microlumbar discectomy. Is it safe as an outpatient procedure? Spine (Phila Pa
1976), 1994. 19(9): p. 1070-4. 14.    Deyo, R.A., S.K. Mirza, and B.I. Martin, Back pain prevalence and visit rates: estimates from U.S.
national surveys, 2002. Spine, 2006. 31(23): p. 2724-7.

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