Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.
Next week's question: What is the most difficult conversation you've ever had with a colleague?
Please send responses to Anuja Vaidya at email@example.com by Wednesday, April 12, at 5 p.m. CST.
Question: What techniques and technologies should no longer be used in spine care? What are some alternatives?
Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): From my experience, I believe open surgeries are excessive for simple single level procedures such as laminectomies. I believe minimally invasive procedures can be employed instead for these types of surgeries. Compared to open surgery, studies have shown MIS to decrease complications and postoperative pain for patients. I have successfully employed these techniques in my own practice and can clearly see the benefits.
Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Open posterolateral lumbar fusion. New advances in instrumentation and MIS fusion techniques make this procedure much more invasive and traumatic than necessary for most patients with degenerative spine conditions.
Payam Farjoodi, MD. Spine Surgeon at Center for Spine Health at Orange Coast Memorial Medical Center (Fountain Valley, Calif.): There have been several iterations of intradiscal injections over the years for disc degeneration, however these techniques have not shown any long-term benefit. Discograms are being used less and less and I believe this is a diagnostic technique that will no longer have a role in spine surgery.
Thomas A. McNally, MD, Director, Chicago Spine Center at Weiss Memorial Hospital: Technology has resulted in better instrumentation, visualization and imaging, and is making the way for more minimally invasive spine surgeries. Still, there will always be a need for open surgery, especially for patients with severe scoliosis or tumors on the vertebrae.
Discectomies are the only procedures that are almost exclusively minimally invasive. These days, there really isn't a reason for an open procedure to correct a routine herniated disc on the lower back.
With robotics and image-guidance becoming more refined, we will likely see those technologies making the operating more efficient. These high-tech tools enable preoperative planning on 3-D computer-built constructs and precise placement of instrumentation during surgery. The best part of these advancements is they benefit the patient, providing quicker healing and improved patient outcomes.
Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Interspinous technology has come a long way, thankfully; but in terms of [a] particular hardware, I would rather do without.
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