Good Morning Spine

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I try very hard to managed the expectations of patients regarding surgeries. Even less invasive surgery using smaller incisions does not mean a perfect result. All spinal procedure have less then ideal results because there are always permanent damage ffrom disc heniations, chronic compression from strnosis, spinal fractures , and an array of degenerative conditions. We as
surgeons, only can try to reverse as much as feasable, these abnormal processes but this is still not “perfect” by any definition. However, 70 to 80 percent improvement is still quite an improvement for those suffering real. pain and weakness in their day-to- day lifestyle. Fortunately, newer technologies has given us choices and patients need to do their homework.
I stress this to excessive degree I find a subset of patients that do not hear these facts prior to their surgery. In the end, trying to explain the positives of surgery in a honest way can be very frustrating to surgeons. For this reason all surgeries should be a last options in the event patients are disappointed with their outcome. Other surgeons should be mindful how many of their unhappy patient end up complaint about their poor results to other spine surgeons. We as surgeons, must constantly remind patients of the real outcomes and challenges surgeons face giving honest solution for our patient.

I have recently completed a review of my last 1000 surgeries and specifically looked at results. Clearly the use of smaller implants and less hardware has showned to make a difference. Patients should understand that maintaining stabilility after decompression does require inserting devices. When bone is remove the spine will start to collapse in a significant number of surgical cases unless there is insertion of implants. Fortunately, we use smaller incisions in both the neck and lumbar spine. I try using models to explain the insertion process to each patient. I still maintain the majority of patients do not need any surgery.

I find it very good that patients r using the Internet prior to their doctor visit. Proper research is key to managing patient’s expectations. I demand that patient know my credentials and should have some idea of my experience in number of surgeries and length of time in practice. I also give specific information on research and organizations that confirm what i most perform as a surgeon. Taking the mistery out of the process allows for much better communications. We also try to give many non-surgical options by providing several other services such as physical therapy,pain management, chiropractics,neurology , and many other services.Choices r important as every patients has a unique set of needs and we try to be sensitive in providing multiple answers as a team of professionals.

Most patients r very nervous to see a spinal surgeon which is to be expected. However, only 10 percent need surgery and most do well with therapy, injection,and mild medication.In the event there is a need for removal of blockage from a her rated disc or spinal stenosis, less invasive allows much more raid return to activities. More importantly, lower complications. I see so much more comPlications from over use of drugs or excessive injections without a clear diagnosis.I have reviewed the results of over 3000 surgery and pleased to see great progress! Always consider second opinions and do your homework. The Internet is a great resource.

I have found that patients are most satisfied when their surgeon gives them very specific goals after surgery with a timeline to achieve functional gains. Patients expectations are extremely important to me, while managing their care regarding cervical or lumbar procedures.  This usually requires performing a variety of newer, and less invasive,  procedures that enable a shorter length of stay in the hospital and a more rapid return to activities such as golf or other sports.

I am very pleased with the collaboration of Dr Dorcil and myself, for obtaining excellent outcomes after ACDF surgery. We have been able to reduce surgical times, on a two level procedure, to less then two hours, including iliac harvest. A team approach is the secret. The incisions are less then two inches and post-operative pain is very minimal. Most patients should understand that weakness, balance issues, and failed epidurals should lead one to a search out for a surgeon’s care. Often times, a permanent loss of function can be avoided if patients seek these less invasive surgeries early on.

Often times, I find that there is a lot of confusion amongst patients that read articles on the Internet or in the newspapers about minimally invasive surgery. As spine surgeons, we want to perform smaller incisions so that recovery will be less eventful. Be assured patient outcomes is still the gold standard. I still see a great deal of failed back surgery because the primary cause of compression by bone or disc has not been completely removed. I have performed well over a thousand revisions surgeries and continue to be amazed that the primary pathology is not removed during surgery. In many cases , the patients still have leg pain or weakness most often from the Lumbar 5 nerve root which is still the primary cause of failed back surgery. Patients should not be confused that removal of compression and some type of stabilization implant will be necessary for real results. Laser is just a cutting tool and addressing the above has not changed by using laser during the procedures.The amount of failed back surgery due to claims of small incision as outpatients procedures for complex spinal pathology still amazes me each day. Buyer beware still applies!

I want patients to realize that there are so many new options to treat neck and back pain without surgery. Should pain continue, we offer less invasive procedures that can return patients to a quality of life that they have been missing out on. However, surgery is not perfect and your doctors should always be conservative with their promises. I usually try to obtain a 70 to possibly 80 percent improvement. In most cases, patients are very pleased with these kinds of results. I. also spend a great deal of time going over alternative options and complications. Our goal is is to improve results while lowering the incidence of complications (infection, hardware failure, and cardiac events.)  In general, these new procedure have great success compared to just a few years ago.  Quality of life is the primary issue for most patients. All patients should look carefully at the credentials, experience, and publications by their surgeon. We still have a long way to go providing great outcomes with low risk.

I want patients to realize that these newer procedures have very much improved return to work and ability for return to activities such as golf and tennis. We use small er incision with short hospital stays to even improve outcomes. In particular, surgery for spinal stenosis or disc rupture can be very rewarding. We always first try non- surgical approach and only surgery for a small percentage that fail injection or therapy. However, I continue to see a great deal of patients treated poorly by non-spine specialist not trained offer all options.

Patients should be excited that less invasive procedures for neck and back surgery allow return to work in one week with so much less recovery. The technology allows placement of small implants to replace the disc that has degenerated over time. I see so many patients having spent years with pain management not knowing there are real options. We still use a complete team of non-surgeon MD’s to review all options prior to making a decision.