Like all specialties, spine surgery is unique and has its own set of rules and guidelines. Here are the things spine surgeons wish other healthcare professionals knew about the profession:
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. Becker's invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at email@example.com by 5 p.m. CST Wednesday, March 15.
Editor's note: Responses were lightly edited for clarity and length.
Question: What's something you wish non-spine surgeon colleagues in healthcare understood about your job?
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): I wish more non-spine surgeon colleagues in healthcare understood the importance of early referrals to spine surgeons. I often see many patients that have been suffering for a long period of time, and an early referral from primary care providers and pain management providers to the spine surgeon would create a timely and efficient evaluation, workup, and treatment plan, particularly with initial conservative management approaches and monitoring when surgery becomes appropriate. I believe a large number of patients in need of a spine surgeon referral are being overlooked and if referred, the patients would be able to develop rapport with the surgeon so that any surgical recommendations or offerings would not shock those patients.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: My other surgical colleagues do not understand that a spine surgery is not like taking out a gallbladder or replacing a hip because of its complexities of motion and proximity to neural and vascular structures. Because of 3D movement and anatomical complexities, spinal surgery is fairly hard to replicate exactly from patient to patient. The anatomy from person to person can vary wildly and so a great deal of training is necessary to be able to execute a good operation. Also, they should know that the vast majority of spine surgeons are careful, surgically very competent, and considerate of their patients, and want to do the right thing by them.
Pawel Jankowski, MD. Hoag Pickup Family Neurosciences Institute (Newport Beach, Calif.): Something that I wish my non-spine surgeon colleagues had a greater understanding and appreciation for is "who is" and "who is not" a candidate for spine surgery. Just because a patient has a specific pathology that lends itself to surgery, it does not mean that the patient will "feel" better after the procedure. The patient's physical and psychological disposition are key substrates in producing a successful outcome. It’s not uncommon for our non-spine surgery colleagues to refer patients that have a pathology seen on radiographic imaging and then be frustrated that the patient was not taken to surgery. In order for us to curb some of the negative stigma that is associated with various spine procedures, we need to select our patients carefully to ensure the best chance of successful outcomes.
Edward Perry, MD. Swift Institute (Reno, Nev.): I would like other specialties to understand the tremendous progressive pressure in spine care delivery in the last five years. The pressure spans from access for our patients to surgery, to the rate of denials for even the most basic non-surgical care, to the logistical restraints with value-based care and its intricacies, and the significant drop in reimbursement for spine over the past ten years. Yet, despite the growing challenges, we continue to strive for the best standard of care, even with longer hours, more complex patients, and decreasing income, because it is still the best surgical specialty to incorporate cutting-edge technology and intricate anatomic work.
Noam Stadlan, MD. NorthShore Neurological Institute and NorthShore Spine Center (Evanston and Skokie, Ill.): One of the biggest obstacles to efficient and high-quality spine care is the lack of emphasis on the physical examination and the lack of emphasis on arriving at a clinical diagnosis. Sometimes serious deficits and/or deterioration are missed due to lack of a thorough exam and/or documentation. On the other hand, sometimes the diagnosis given to the patient is simply a reiteration of a radiographic finding when the patient’s symptoms and exam indicate an entirely different problem. Radiology readings are also a source of inefficiency because seemingly worrisome readings don’t also imply a worrisome problem, and the exam and history are crucial to differentiating the two. I wish that there was an increased emphasis on physical exam and diagnosis by non-spine colleagues, and that patients were more accurately triaged to surgical versus non-surgical care.
William Taylor, MD. University of California San Diego: You can do the same procedure with the same effort on a similar pathology and end up with different outcomes. Each patient is different, nuanced, and brings a set of expectations to the procedure — all of which bear on outcomes and success.
Roy Vingan, MD. New Jersey Brain and Spine (Oradell): After 30 years in practice, I wish that non-spine colleagues would truly understand that neurosurgeons bring a special additional level of expertise to spine management and in the surgical arena are spine specialists in all aspects. Neurosurgeons are often first thought of as brain surgeons, and yet our daily practice can range from 60 percent to 100 percent spine-focused care, depending on the individual practice. I would also suggest that our first agenda is finding reasons not to operate and not to be thought of as "knife happy." Our collective goal remains the education of our patients so they may have the understanding of what the best treatment options are for them as they deal with the vast amount of information between marketing and the internet.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Misconceptions about spine surgery are as prevalent as the too-many-to-count experts on the internet. Spine surgery is medical therapeutic for lower back pain issues, nerve injuries and spinal deformities. When mistruths are investigated and dispelled, educated healthcare choices can be employed to optimize spinal conditions and health. Past myths about post-operative pain, recovery, and inactivity have eased, yet misapprehensions about surgical last resort as an option may not apply. In cases of neurological compromise and decline, surgery may be the leading option for preservation of function. Competency and prejudicial inclinations are dubious issues among surgeons that both patients and non-spine colleagues should consider and be cognizant of.