Dialogue with patients often includes questions about procedures for spine surgeons. Common threads include concerns about spinal fusions and how they will feel after surgery.
Seven spine surgeons shared with Becker's common patient questions they hear and how they address them.
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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Editor's note: Responses were lightly edited for clarity and length.
Question: What concerns do patients voice most when it comes to spine surgery? Why?
Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (Livonia, Mich.): It still surprises me to see how many patients voice concerns about "fusion." Their concern usually stems from a conversation with either a friend or family member who had an unusual and rare less-than-desirable outcome, such as continued pain or new pain. Historically, fusion surgeries sometimes required longer postoperative recovery processes that could take weeks to months. However, using new minimally invasive techniques, such as the ones that I acquired in my fellowship training, allow patients to have shorter hospitalization stays, less postoperative pain and quicker return to activities/work within weeks. The way to address the hesitation from the patients is to acknowledge their concern, but highlight the fact that fusion is often necessary for stabilization of the spine and helps to relieve mechanical neck or back pain. Successfully addressing their concerns will help them understand the importance of a fusion surgery.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Patients in nearly all of our first initial encounters voice that they don’t understand the "why" of the surgery. I will start out by saying that not every patient should get a surgery, in even the busiest spine surgeon's office (i.e. the Oprah approach to surgery). The patients that do need an operation really need to understand what they are having done and the reason I or anyone is going to do it. Surgeons should be comfortable enough to be able to explain the philosophy of the operation and the reason why it is being done. The patients are entrusting their surgeon, their well-being in the hands of a stranger, more or less. Honesty and mutual respect is a great foundation for a good patient-doctor relationship. The trust established therein is a very strong bond, and it is the right thing to do for the patient.
Sohaib Hashmi, MD. UCI Health (Orange, Calif.): Patients having treatment for spinal disorders in the modern era most commonly ask about chances of success and failure. Whether treated with nonoperative conservative care or surgical management, patients would like to understand the probability of symptomatic improvement especially between various surgical solutions. Predictive analytics for patients undergoing decompression or decompression and fusion surgery are continuing to improve with higher level outcomes literature. Upcoming studies will give further insight into radiographic and patient reported outcomes metrics. With the use of more reliable and accurate imaging modalities, we will improve our understanding of the effect of global sagittal and coronal spinal alignment and segmental bone density. Patient-reported outcomes tracked pre-and postoperatively combined with patient expectations will allow us to better counsel our patients.
Mohammed Khan, MD. New Jersey Brain and Spine (Hackensack): Postsurgical pain is understandably a major concern for many patients because of the potential for discomfort and the need for pain medication during recovery. Complications and risks associated with surgery can also be a source of anxiety, including infection, bleeding, nerve damage, and other potential adverse outcomes. Patients may worry about the long-term effectiveness of the surgery, as well as the possibility of needing additional surgeries in the future, especially if their underlying condition is chronic or progressive.
Other common concerns include the length of the recovery period, potential limitations on mobility and activities, and the impact of the surgery on the patient's quality of life. Patients may also have concerns about the cost of the surgery and the impact on their finances, particularly if they are uninsured or underinsured.
Overall, patients' concerns about spine surgery reflect the complexity of the procedure and the potential impact it can have on their health, well-being and overall quality of life. By listening carefully to patients' concerns and addressing them with empathy, healthcare providers can help alleviate anxiety and ensure that patients feel informed and well-prepared for their surgery and recovery.
Kirk Owens, MD. Norton Leatherman Spine (Louisville, Ky.): I tend to hear two common concerns from patients considering spine surgery. Firstly, it is typical for a patient to ask if they can become paralyzed if something goes wrong with the surgery. Although this rarely occurs, it must be discussed thoroughly. Some surgeries place patients at higher risk for injury to the spinal cord (cervical myelopathy, tumors with spinal cord compression, epidural abscess) while other common procedures (lumbar laminectomy and discectomy) have little to no risk.
The second most common concern I hear relates to patient expectations. They will often express concern about their ability returning to normal activity. This, too, depends a lot on the type of surgery. A patient with a successful discectomy, laminectomy or single level cervical or lumbar fusion can have realistic expectations to return to a pretty normal level of activity. Conversely, a patient undergoing a large deformity surgery needs adequate counseling to explain the significant limitations they may have associated with a long, multilevel fusion surgery.
Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Spine surgery has evolved tremendously over the past several decades. Even lumbar laminectomy used to be a very invasive procedure with significant muscle dissection, blood loss, need for an inpatient hospital stay and prolonged recovery. Un-instrumented lumbar fusions required an even more invasive approach with painful iliac crest bone autograft harvesting, and either a body cast or a large and uncomfortable brace for a long period of time in order to achieve successful fusion. Complications were common and blood transfusions were frequently needed due to significant intraoperative blood loss. Traditional posterior lumbar interbody fusion technique required significant nerve retraction with a 17 percent rate of new postoperative foot-drop.
The field of spine surgery has advanced significantly since those times. Lumbar laminectomy and discectomy, cervical fusion and cervical disc replacement are now frequently outpatient procedures with quick recovery and minimal blood loss. With better implants, surface technologies and current bone graft substitute choices, the need to harvest iliac crest autograft is now very rare. Lumbar fusions, even with deformity correction, can now be done in a minimally invasive fashion with much quicker recovery, shorter hospital stay (sometimes outpatient), much lower rate of complications and much less postoperative pain.
Unfortunately, the stories of how "bad" spine surgery used to be still persist. The new advances in spine surgery with better outcomes have not become well-known not only among the general population but among other medical professionals as well. The main concern that the patients voice to me when faced with a choice to undergo spine surgery is that they have been told by their family, friends, and often their primary care doctor that spine surgery comes with prolonged recovery, high risk of nerve damage, paralysis, permanent disability and significant pain. I spend a lot of time dispelling the myths about modern spine surgery and explaining to my patients that we have come a long way from the way these surgeries were done in the past. At the end they feel relieved and willing to proceed with the surgery to help their pain and disability. The great outcomes of modern spine surgery speak for themselves.
Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): The patient still is afraid of having spine surgery in general, especially open surgery or fusion surgery. They usually knew someone or heard the horror of spine surgery. I love to spend time educating and explaining to them how today's surgery is different from what we did in the past. Many patients are candidates for endoscopic spine surgery, minimally invasive spine surgery, and motion preservation surgery. Moreover, I spend time showing them the scientific data, so they have a better understanding. At the end of the day, I love how I can educate them and give them options. The decision is theirs.