Bone and Joint Institute of Tennessee Surgery Center, a state-of-the-art ambulatory surgery center (ASC) that opened earlier this year in Franklin, TN, has now expanded its orthopaedic case load to include outpatient spine procedures. John W. Klekamp, M.D., an experienced surgeon and partner in the ASC, recently performed the first one, a lumbar discectomy, and has since completed six more similar spine surgeries at the center.
“It was a lumbar discectomy at L 4-5, on a young patient who had been struggling with nerve pain for about three months,” Klekamp recalls about the ASC’s first spine procedure. “His initial MRI showed a large disc herniation. We had tried all conservative measures, including medications and epidural shots, but ultimately decided that the discectomy was his best option. So we did the surgery, and it went wonderfully. It started at 7 a.m. and he was out of our surgery center by about 9 a.m.”
While lumbar discectomy is often completed on an outpatient basis in a hospital operating room, Klekamp says doing the procedure at the ASC was more efficient. “At our surgery center we are very tuned-in to the outpatient care side, which helps get the patients out quicker.”
One contributing factor, Klekamp says, is Bone and Joint Institute of Tennessee Surgery Center’s approach to anesthesia: “Our anesthesiologist, Katherine Dobie, is an expert, well-versed in outpatient orthopaedic procedures. She came to us from Vanderbilt where she was Head of the Outpatient Department for Anesthesia for orthopaedic care. She was the anesthesiologist for this case, and the patient did wonderfully.”
“We caution patients that even though they’re feeling a lot better, they should somewhat limit their activity, to help guard against the risk of a recurrent disc herniation. Most studies on discectomies show about a 10 to 20% chance of a recurrent disc herniation after the surgery, within three months,” Klekamp explains. “So, to limit this risk, we usually suggest not lifting much more than 10 pounds for the first six weeks. And then we go from 10 pounds up to about 30 pounds for another six weeks. And then at three months we usually allow patients to go back into their normal activities.”
Bone and Joint Institute of Tennessee Surgery Center’s first lumbar discectomy, and the six that followed, are just a beginning. Klekamp says he is very excited about broadening the scope of procedures done at the new ASC.
“Currently we are limiting it to lumbar procedures, but my plan in six to eight weeks, is to expand to neck surgeries, both cervical disk arthroplasties and anterior cervical discectomy and fusions. And then eventually, hopefully in the next year or two, we’ll consider doing outpatient lumbar fusion surgeries.”
“I think all of my partners would agree, everything about the ASC is putting the patients first,” summarized Klekamp. “Throughout my career I have found that if you put patient care and patient outcomes first, everything else will fall into place.”
“So as far as spine and beyond, our approach begins with a collaborative effort, including the patient. The key is starting even before the procedure is performed, by creating patient expectations that we are going to take care of them, that their pain will be controlled, that we have a surgical and anesthesia team that works collaboratively together. And, that these procedures can be performed safely, efficiently, with the highest quality of patient care to get the best outcomes, in a convenient and safe ASC setting.”
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