Good Morning Spine

I do recommend a less complex procedure if patients have complex co-morbitities such as cardiac requiring blood thinners. However, sometimes this will require taking them back for a second procedures if the results are not adequate rather then having one 4 or 5 hour first surgery. Safety ranks number one in my planning.

Sciatica is a very common problem and one should not panic. Greater then 90 percent resolve without surgery. I usually give medication and complete therapy program that works for most patients. If symptoms are severe a nerve block is performed in the office. Acupuncture is also offered as well as decompression using special tables. Surgery only as a last resort after above fails.The first disc surgeries were in 1930’s so this treatment was not even offered years ago and patients did recover.

One of the most concerning complication of spinal surgery can be an infection. This reported problems can occur in 15 percent of elective surgeries requiring hardware such as rods and screws. I believe that if patients seek early contact with their surgeon the consequences can be minimized. Unfortunately, any delay can serious change the outcome. I give everyone of my patients my home and cell number for this very reason. Early detection can allow prompt initiation of antibiotics that can resolve the superficial wound infection from becoming a complex recovery.When a patient has redness or drainage that occurrs 1 vto 2 weeks after surgery they must become aggressive to let their surgeon know.

I have recently begun to ask patients to consider their diet and nutritional preparation prior to surgery. We ask all patients to take vitamins but review specifics if they are taking any herbal products. I also try to get them exercising within their pain limits two weeks prior to surgery as well. We all feel, as a team ,this has clearly improved patients outcomes and ability to handle pain in post- operative phase of their care.

Our team can now prevent 95 percent of need for sugery when patients are compliant. We now use acupuncture and added fitness training to the team. Surgery is now less invasive with rapid return to activity. So much progress in just a couple of years.I am still amazed that patients do not look at all their options and try our approach. Wellness is fundamental to a good team approach.

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!