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January 07, 2026
2 min read
Key takeaways:
- All patients undergoing ALIF with posterior pedicle screw fixation in an ASC were discharged within 23 hours of the procedure.
- Patients also had no hospital transfers, blood transfusions or early readmissions.
Results showed anterior lumbar interbody fusion with posterior pedicle screw fixation may be effective and cost efficient and pose minimal complications within the immediate postoperative period when performed in an ASC.
“A growing volume of highly complex spine surgeries can now be performed safely and effectively in the outpatient setting,” Steven J. Girdler, MD, of DISC Sports & Spine Center in Newport Beach and Marina del Rey, California, told Healio. “This shift offers meaningful advantages for both patients and the broader health care system. Patients benefit from earlier discharge, faster recovery and a reduced risk for hospital-acquired complications, while the health care system realizes substantial cost savings.”
Girdler and colleagues retrospectively reviewed data from 203 patients who underwent ALIF with posterior pedicle screw fixation — also known as 360° fusion — between 2018 and 2024 in an outpatient setting.
“All cases were performed at two high-volume, purpose-built ambulatory surgery centers in Southern California — DISC Surgery Center at Newport Beach and DISC Surgery Center at Marina del Rey, California — reflecting routine clinical practice rather than a narrowly controlled trial environment,” Girdler said.
Experienced vascular surgeons performed all ALIF procedures, and they used a combination of a limited open approach and minimally invasive and percutaneous techniques, Girdler said. He also said both percutaneous and open posterior fixation techniques were used, depending on the surgeon and the patient anatomy.
According to Girdler, all patients were discharged within 23 hours after surgery, with no hospital transfers, blood transfusions or early readmissions in the immediate postoperative period.
“For a procedure that has historically required 3 to 4 days of inpatient hospitalization, these results demonstrate that, in appropriately selected patients and with a coordinated surgical and perioperative model, even complex 360° lumbar fusion can be performed safely and reliably in an outpatient setting,” he said.
In the future, Girdler said he believes spine surgery will follow a similar trajectory as that of total hip and knee arthroplasty and sports-related procedures with a move toward the outpatient setting.
“By demonstrating that a substantial volume of highly complex spinal procedures can be performed safely and reliably in an outpatient setting, this study supports a broader redefinition of where advanced orthopedic care can be delivered and suggests a future in which outpatient spine surgery becomes an increasingly standard component of orthopedic practice,” Girdler said.
For more information:
Steven J. Girdler, MD, wishes to be contacted through Kristien Brada-Thompson at kristien@bradapr.com.
Sources/Disclosures
Source:
Girdler SJ, et al. Outpatient 360 fusion: Is it safe? An analysis of 203 patients undergoing anterior-posterior lumbar interbody fusion (also known as 360 fusions or ALIF+PSFs) in an ambulatory surgery center. Presented at: Society for Minimally Invasive Spine Surgery Annual Forum; Oct. 2-4, 2025; Las Vegas.
Disclosures:
Girdler reports no relevant financial disclosures.
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