Archive for March, 2010
Patient should know that the complication of implants using screws and rods and fusion with greater then four hour surgeries have reported complication ,such as infection,as high as 15 percent . The rates vary from institution to institution but still very high for elective surgery. I really try to stress this fact when chosing a procedure. Unfortunately, less invasive smaller surgery cannot always be an options for certain serious conditions. I try to be very honest going over the treatment should an infection occur. There is also the problem of revising a surgery where claims that an outpatient local procedure was performed that did not work out. These revision cases can have the highest infection rates. It certainly best if the first operation was well thought out and reality based so that revsion rates will be lower. Ask your doctor if they have published results of their success rate. Honest surgeons will discuss these issues in detail.
Patient can now return to golf and doubles tennis within one month of surgery when newer Aspen devices are used. I believe there is more movement and less pain when laminectomy is not performed. I also believe we should strive to put less hardware into the spine unless there is significant instability. Newer procedures are very similar to the transition that happen with stents versus bypass surgery became an twenty years ago. Less is more!
I find that 95 percent of patients can avoid sugery when a nerve block and reasonable medication is used to control symtoms. I find that patients, in my practice,understand the only reason for surgery is failure of non- surgical methods. The newer technologgies of less invasive procedure also allow rapid return to function with less risk of surgical complications. I learned at recent meeting that spine surgeons have 90 percent less sugery then their patient population! A careful team approach is the best place to start.
Motion preservation devices have limited use in surgical treatment at levels causing compression. The decompression and fusion are key especially when there is an associated slip.I prefer Aspen with xgraft combination using unilateral rods if there is a slip and unilateral leg pain.
Just returned from major spine meeting. Highlights are that less invasive surgeries are effective but use of screws and rods should be limited to very specific use.Research shows that surgery best option for severe stenosis with buttocks and leg pain.Epidural mills have really have not been shown to be effective in longterm controlled studies. The new theme is is evidence based medicine and surgery when non-surgical options fail. Look at credentials and your doctors experience!
I am now requring prevention as part of treatment. We have started looking at wellness as fundemental part of spine treatment. I find that less invasive surgery is already very much improving as a treatment option when patients are in better condition. Again, I treated a patient with lumber stenosis also with a pacemaker,defibulator, mechanical heart valve using new techniques as this would not have been possible 5 years ago.The advances for patients with stenosis or herniated disc is very much different then just a few years ago.
Remember that first disc surgery performed about 1935 so what happen prior to that time? People were more physically active causing the outer portion of the disc to be stronger so less likely for the nuclear material would leak out as a rupture with compression of sciatic nerve. Patients most do more weight bearing and exercise to keep the outer disc strong. Real health means prevention including exercise low carb diet without processed foods.There is so very much unnecessary surgery!