Day-case open lumbar spine surgery: a United Kingdom experience

OBJECTIVE: To evaluate the safety, feasibility, and clinical outcomes of day-case open lumbar spine surgery performed in a stand-alone surgical hub in the United Kingdom. METHODS: A retrospective review was conducted of patients undergoing day-case open lumbar decompression or discectomy between November 2022 and August 2024 at a dedicated Day Treatment Centre (DTC). Inclusion required predefined surgical, anaesthetic, and social suitability criteria. Data collected included demographics, comorbidities, operative details, complications, length of stay, readmissions, and clinical outcomes at follow-up. RESULTS: Sixty-eight patients were included (51.5% male; median age 53 years). All patients were ASA grade I-II. Lumbar decompression for canal stenosis was performed in 37 patients. The majority (23/37; 62.2%) were performed at L4-5. The remaining 31 underwent unilateral discectomy; 17 (54.8%) at L4-5 and the rest at L5-S1. Five of these patients had a revision, unilateral discectomy. Complications occurred in 7.4% (5/68) of patients: one postoperative haematoma requiring emergency evacuation, one symptomatic CSF leak requiring readmission and conservative management, and three transfers to the tertiary neurosurgical centre for severe pain and urinary retention (managed conservatively). Median length of stay was 1 day. At a median follow-up of three months (range 2-22 months), 82.4% (of patients reported full or partial symptom improvement, while 17.6% reported no improvement. CONCLUSIONS: Day-case open lumbar spine surgery in a dedicated surgical hub is feasible and safe in carefully selected patients, with low complication rates and favourable short-term outcomes. However, its impact on reducing the wider neurosurgical waiting list may be limited.