Informed consent has become more important than ever for spine surgeons and their patients, and the conversations are going beyond the immediate post-surgical outcomes.
Two spine surgeons discuss how discussions around informed consent have evolved.
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Question: How do you approach informed consent differently today than you did early in your career, especially around long-term implant considerations?
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Early in my career, informed consent was largely a recitation of risks like infection, neural injury, hardware failure and the standard list. It was accurate, and it was inadequate.
What I’ve come to understand is that true informed consent for spine fusion requires the patient to genuinely grapple with the long-term trajectory of their spine, not just the perioperative period. That means discussing adjacent segment disease, the well-documented phenomenon of accelerated degeneration at levels adjacent to fusion, and being honest that the natural history of fusion is often not a single operation. It means discussing what hardware in their body means for future imaging, future procedures and future decisions made by surgeons they haven’t met yet.
I now spend significantly more time on what I call the “downstream conversation.” What happens in years three, five and 10? What does fusion mean for the levels above and below? What will we do if this fails? I want patients to understand that a spine fusion is not an endpoint; it’s a commitment to a relationship with their spine that extends well beyond recovery.
This changes who consents to surgery. Some patients hear that conversation and decide they aren’t ready. That’s informed consent working as it should. The goal is to ensure that the patient who says yes to surgery genuinely understands what they’re agreeing to — including what we don’t yet know.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The only recent change to a long process of the question/answer sessions of surgical delivery are more particular to discussions surrounding expectations and outcomes. Comparable to all spinal surgeons, standardized conservative measures have been applied and enervated, channelizing shared decision making among involved parties. Reported patient understanding of surgical risk and outcomes are approximately 30% across inquiries, clearly underpinning the level of comprehension and need for both aggregate and reiteration of query. Model presentations of actual implants are habitually demonstrated to all patients and families as a further method of understanding and precision. Both advanced providers and I close all discussions with mutual assurances.
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