Good Morning Spine

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.

I need to make sure patients have a clear picture of my goals for their spine care. I always try a combination of therapy , medication , and nerve blocks that work in the vast majority of patients. If symptoms of pain and weakness continue ,then a surgical procedure is considered. We now use less invasive technology that allows hospital stays of one or two days for complex procedures and outpatient for simple disc surgery. I still see so many patients that are on high dose of narcotics not knowing about the many new less invasive technologies. Always consider two opinions!

In this New Year, I wish all my patients well! There is so much new innovative options for patients to live a more productive and less painfull lifestyle. I am so please to see the gratified patients from these new less invasive procedures. Still not a perfect world but much improvement in function with lower risk from surgery.

So many patients come to me confused about their problems. Most spinal problem that cause pain are due to compression of a nerve. The solution is mon- surgical if minor compression but if there is pain down leg or arm then surgery becomes an option. The newer less invasive procedure require placing implants to open the windows where the nerves exit the spine. Patients need to find surgeons trained in performing these newer procedures. Surgical times are shorter and outcomes much more favorable to alleviate sciatica and return patients to high quality of activity.

I wish all a wonderful holiday season from all of us at SPOSI ! Recently , I, have seen a patient with operative wound infection.Patients need to be vigilant after surgery. They should call their surgeon if they develop a temperature greater then100 degrees or redness of their incision. Also, any drainage should be reported after surgery as a precaution. Early intervention with antibiotics and possible wound packing and cuture can nip big problem from occurring.

This holiday seasons people should be careful setting up their tree. Lifting injuries can be quite common. Ask for help and raise your tree without using your back muscles. I also am commenting on recent articles concerning hospital-based medical errors. Families of patients should review medications given to their family and ask for explanation so as to know proper medications after elective back surgery.