Good Morning Spine

Archive for the ‘Spinal Medicine’ Category

I find it very gratifying to help patients that have had failed back surgery. Many can be helped with new technology and careful review of symptoms and physical examination. Last week, I performed five surgeries with excellent early outcomes . Patients should not give up hope.Please always bring your records of op operative reports or pain management treatments to your office visit. Many failed surgeries are the results of simple outpatient procedures that were never a reasonable options and doomed to failure . Be careful with unproven laser claims or other procedures that can not be validated with scientific studies!

I continue to see patients that have been sent to pain clinics for first-line treatment of back or neck pain. Unfortunately,many are not examined and just given drugs or injections. In many cases,they come to need these drugs too often. The issue is diagnosis and then treatment! The newer less invasive spinal procedures can eliminate the need for excessive narcotics. I am amazed that diagnosis such as signal stenosis is so poorly diagnosed when these procedures give such great outcomes. Please consider all your choices!

Patients should understand that the cervical spine( neck) is much more forgiving when there is compression from a disc or spinal stenosis. One major reason is the load on the neck is about 8 pounds from the head. Therefore,many non- surgical options may be helpful including medication,therapy, traction to name a few. However, when pain radiates into arms or there are associated balance issues then more aggressive treatment may be necessary.Unfortunately, there is a point when these symptoms may not recover if removal of blockages due tio arthritic spurs or disc are not surgically removed. The good news is that smaller incision less then two inches from the front of the neck can be performed with very rapid recovery.Again, only for reasonable failed conservative treatment.Most patients are extremely gradified with their results.

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!