Picking favorites: The procedures 7 spine surgeons enjoy performing the most


Spine surgeons will master an array of procedures in their career, but some stand out for their welcome challenges or rewarding patient outcomes.

Seven spine surgeons told Becker's about their favorite spine surgeries to perform.

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.

Next week's question: What concerns do patients voice most when it comes to spine surgery? Why? 

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Wednesday, May 17.

Editor's note: Responses were lightly edited for clarity and length.

Question: What's your favorite spine surgery to perform? Why?

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): My favorite spine surgery to perform is the resection of an intradural extramedullary spinal tumor. Spinal tumor resections involve a certain complexity that is intellectually stimulating, as well as gratifying for the patient when they have an improved postoperative outcome. Often these tumor resections require a methodical, multistep approach, which can include laminectomy, use of intraoperative ultrasound before opening the dura for real-time localization, opening of the dura with microinstruments, use of intraoperative neuromonitoring with probe stimulation for safety, and microsurgical dissection and resection of the tumor, then water-tight dural closure. Depending on tumor size and location, these surgeries may also require instrumentation. Spinal tumor resections are important surgeries that should not be overlooked in the neurosurgeon's armamentarium.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: My absolute favorite operation to do is posterior C1-2 fusions. It is by far the most challenging, technical and most effective surgical technique in our armamentarium. I learned from a real master, Volker Sonntag, MD, who, along with Curtis Dickman, MD, added a great adjunct to the old standby harms construct, by looping a bone graft under the C1 lamina that I still do, really reinforcing the construct. Helping patients avoid a devastating neurological injury from a dens fracture, or by helping their chronic upper cervical pain from instability, I find it the most rewarding and exhilarating surgery I do. At times, it can be a bit of a nail-biter, and there are obvious pitfalls when doing it, but I still love doing them.  

Luke Macyszyn, MD. DISC Sports & Spine Center (Newport Beach, Calif.): One of my favorite spine procedures to perform is the resection of intradural spinal tumors. These tumors are slow growing, but when they start to become symptomatic, the patient develops significant neurological symptoms that may include numbness, weakness and even paralysis. When these lesions are identified in a timely fashion, surgical resection frequently leads to almost immediate relief of the symptoms. This is extremely gratifying not only for me but also for the patient. At DISC, we have made significant advances in the resection of these tumors and are now able to offer these surgical interventions to patients in an outpatient setting using minimally invasive techniques. Thus, patients can undergo this life-saving surgery in a comfortable and convenient setting and return to their lives in a shorter time than ever previously thought possible.

Emeka Nwodim, MD. The Centers for Advanced Orthopedics (Bethesda, Md.): I enjoy performing nearly all spine surgeries because of the relief they provide to patients with critical circumstances or those who have tested conservative measures with little to no success. Furthermore, I have always admired and have been intrigued by the anatomy of the spine. The spine is an area of the human body with a unique confluence of anatomical structures, tissues and function. The sensitivity that is required to surgically manipulate the spine for the benefit of people amazes me.

With that being said, I would say that my favorite spine surgery to perform is the laminectomy because I have seen it provide great benefit to people in pain. When performed appropriately, the laminectomy can have a significant impact to those struggling with intolerable sciatic pain all while minimizing the compromise of the spine's integrity and mobility. 

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): In cervical spine, my favorite surgery to perform would be cervical disc replacement. In properly selected patients it achieves complete decompression of all neural structures while preserving motion. The patients recover quickly and get great clinical results and fast return to work/function. With so many new implants available now, I am able to customize the best implant for each patient based on their pathology and level of activity.  

In lumbar spine my favorite surgery is minimally invasive single-position lateral lumbar interbody fusion with robotic assistance for percutaneous pedicle screw placement and fusion. The procedure allows me to stabilize unstable lumbar spine levels, restore disc height, reduce deformity, and achieve decompression in the most efficient and least invasive manner. Robotic assistance allows me to place pedicle screws accurately through the smallest incisions without having to reposition the patient. The patients recover much quicker, have a lot less pain, and are much less likely to have complications than with traditional open lumbar fusion surgery.  

Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): I tell patients all day every day that my favorite spine surgery to perform is an artificial disc replacement. Selfishly, I love to have and see happy patients, and if you were to tell me I had a day full of postoperative patients with disc replacements, I'd be the happiest spine surgeon because I know I'm going to see happy patients. I routinely say that if I could, I would give up all other forms of spine surgery and just perform artificial disc replacements for the rest of my career! I find the conditions we treat to be fascinating, and I believe the surgery is technically satisfying and elegant. Since artificial disc replacements can be done in the outpatient setting, the postoperative recovery is not particularly difficult and the patients do beautifully, with a quicker return to doing the things that they love. I go home feeling tremendous gratification and satisfaction with the day's work. It's a win-win for all parties involved!

Noam Stadlan, MD. NorthShore Neurological Institute and NorthShore Spine Center (Evanston and Skokie, Ill.): I have two favorite types of surgeries. I enjoy performing surgeries where the patient has a high likelihood of an excellent outcome, such as cervical disc replacements for herniated disc or lumbar decompressions for severe stenosis. I also enjoy more technically challenging surgeries and finding elegant solutions for difficult and unusual problems.

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