Post-operative Short-term Ketorolac Is Associated with Reduced Length of Stay in Single-level Midline Lumbar Interbody Fusion (MIDLIF) for Degenerative Mobile Spondylolisthesis

Introduction: Degenerative spondylolisthesis can be associated with significant pain and disability. Lumbar instrumented fusion is a commonly performed procedure for symptomatic mobile spondylolisthesis refractory to non-surgical treatments. Midline lumbar interbody fusion (MIDLIF) with cortical bone trajectories has been described as an alternative to transforaminal interbody fusion (TLIF) with conventional pedicle screw trajectories. Short-term post-operative ketorolac may facilitate decreased pain and decreased length of stay. As part of the evolution of routine clinical practice for patients undergoing single-level MIDLIF, a regimen of short-term scheduled postoperative ketorolac was instituted (30 mg at the end of the procedure followed by 15 mg every 6 hours for 24 hours). Herein, we investigated the effect of ketorolac on length of stay.

Methods: We retrospectively reviewed the medical records of patients who underwent single-level MIDLIF for symptomatic degenerative mobile spondylolisthesis. 15 consecutive patients (4 male, 11 female) received the new ketorolac post-operative regimen between January and October 2022. This cohort was compared to a group of 15 consecutive patients undergoing single-level MIDLIF prior to initiation of the ketorolac regimen.

Results: Short-term post-operative ketorolac resulted in significant reduction in length of stay from 3.2 +/- 1.2 days in the comparison cohort to 2.2 +/- 0.8 days in the ketorolac cohort (p < 0.05). Baseline demographics were not significantly different between the two groups. Two patients did not receive ketorolac due to underlying chronic kidney disease. No adverse events were observed.

Conclusion : Perioperative short-term ketorolac appears safe for patients undergoing elective single-level MIDLIF for degenerative mobile spondylolisthesis and is associated with decreased length of stay. No complications were observed.