Archive for the ‘Spinal Medicine’ Category

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I try to make patients aware of the newer procedures in spinal surgery. However the gold standard is still complete decompression of the nerve or neural structures. surgeons have many choices.

I believe patients need to take more responsibility before making surgical choices. First off, proper preparation by losing weight,no smoking, full interaction with their surgeon’s recommendations. I continue to see other surgeon’s patients upset after surgery that have no idea what procedure and outcomes were expected. I have observed this over 25 years! I demand that all my patient’s write down their questions and review with them prior to surgery. I also ask them to do Internet research as well know all options fully prior to surgery. I constantly stress that surgery should be a last resort as results are in the 70-80 percent range at best. This area of medicine is very challenging and outcomes are critical to be understood. If surgeon do this, it is much more likely a favorable outcome will occur. I still see tremendous satisfaction but there are a definite unfortunate group that never achieve the success that was envisioned. In my practice, I accept this and look for other options. I do not hesitate to get other surgeon’s opinions. Communication is still very critical to all.

I often reflect on how difficult it must be for a patient to choose a spinal surgeon. Even more challenging, whether to trust a surgeon for the necessity of surgery. Very scary to be the patient with pain and not knowing what to do. I try to give options and ask patients to sleep on it. Only recommend surgery as emergency for very special clinical situations. I want them to know the fit between surgeon and patient’s trust must be mutual for surgery to proceed. I started giving patients’s my cell and home number ten years ago to increase my own personoal belief that surgery was a reasonable option. Obviously, this access exposes me and my whole personal world should results be less then expected. I thought about stopping this added stress as so many physicians thought this was “insane” to give home phone number knowing spinal surgery patients have upwards 20 percent not happy with their outcomes. Fortunately, patients have not abused and the added pressure makes me sure I fully inform and manage patient’s expectations. I find it so very rewarding to improve trust and communication,even when their are rough times after surgery. I hope to continue this service my entire professional career!

I am very pleased with the results of less invasive procedures using interspinous implants. Much shorter surgeries,less infections,and rapid return to activities such as golf and tennis. Patients with advanced stenosis should understand implants give the support for the spinal elements. So many failed surgeries are a result of not using stabilizations in concert with decompression. This very important when there is a slip or spondylolithesis. Patients should expect one day hospital stay and early increase in activity. I still only recommend surgery after failed therapy,injections,and medication.I always spend time discussing possible complications and their frequencies.I consider each patient’s unique qualities in making a final decision on type of surgery which is fundamental.

During the Holiday seasons several risks occur each year. The average weight gain exceeds 10lbs for most of u out there. Many of u are carrying Christmas Trees or trying to lift them upright. The load can cause a sudden force great enough to rupture a disc. Think before lifting and get help with each project. Stringing lights also a risk. As far as all the great food and drinks, cut back portions or avoid one meal a day to balance a big dinner or office party. Try to exercise 45 minutes each day can be a big help as well.Remember,u do not want to ruin the holidays with injuries. Be careful cutting things such as wrapping paper or even a turkey in a hurry. Finally, mad and crazy driver r out there rushing to the next big sales event!

Patient should always do their research! When doctors make claims of great success try to look at all options. However, remember there is a body of knowledge as a basis for much of the outcomes for surgical procedures.I try to show and explain to my patients goals of 70 to 80 percent are reasonable and try very hard to manage their expectations.Claims of a 100 percent should be suspect.Any procedure has real risk that should also be carefully reviewed by your surgeon. Having said all this, patients should remain optimistic as most procedures for acute disc herniations or spinal stenosis are quite successful with timely return to normal activity.

I just return from an advanced spine meetings and want to report my observations.Patients should understand the best improvements after surgery still fall far short of a 100 percent. Even with new technologies, the number of patients with less then 70 percent improvement of their back or leg pain is still the challenge for surgeons. I always spend extra time making sure I explain realistic goals. Unfortunately, we do not have a perfect solutions for back or leg pain due to spinal pathology. Patients going to centers with claims of 90 to 100 results should be very wary!

I am amazed how often patients come to me with misinformation about their condition. They have their own notions about their spine problem and want me to accept a type of surgery that will not work. In particular, if they already know of a procedure that someone else claimed worked for their friend. After 22 years of seeing numerous failed procedures, I try to offer real opportunity for succcess. Unfortunately, this may require placement of devices in spine and two to three days in hospital but the outcomes r well worth compare to unproven gimmick ! Patents obtaining recommendations should then do research on doctor’s credential and look at published outcomes.

I have recently performed a number of revision surgeries and find that results can be very rewarding to patients that have given up hope. Usually, there is a residual area of compression of the spinal nerves that must be released. This requires extensive testing and thought before embarking on another surgery. However, results can be gratifying.