Spine surgeries are intricate procedures, and patients may be worried about the risks the operations pose.
Seven spine surgeons connected with Becker's to discuss how they handle those conversations.
Next question: What is one complex spine procedure early-career surgeons should master?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Sept. 4.
Editor's note: Responses were lightly edited for clarity and length.
Question: How are you approaching conversations about spine surgery risk with patients?
Hansen Bow, MD, PhD. UCI Health (South Orange, Calif.): I believe it is important to discuss with patients realistic risks, benefits and alternatives regarding any surgery that I am proposing. The risks include what I have read in the published literature, seen in my own experience, and observed in the operations of others. I don’t try to downplay the risks, and I try to present the options in a balanced way. However, I also give guidance to the patient regarding which option I would advocate for. In this way, I hope to participate with the patient in making the best informed choice.
Rachel Bratescu, MD. George Washington University (Washington, D.C.): Conversations about surgical risk should ultimately be part of a discussion that is focused on shared decision-making. There is a great deal of trust involved in the surgeon-patient relationship and the privilege of a patient putting themselves in your hands.
Preoperative discussions about risk should be comprehensive, but frank and easy to understand. There should be time made available to address any lingering questions and at times may necessitate a separate pre-operative visit depending on the individual surgeon's workflow. For the most common associated risks, delineation of an action plan may help alleviate anxiety by demonstrating foresight and experience. It is essential to emphasize your involvement in all phases of care, even when things do not go as planned intra-operatively or in the postoperative period.
Michael Dinizo, MD. Kayal Orthopaedic Center (Paramus, N.J.): To me, the most important thing is to be honest and transparent. I do my best to use straightforward language to help patients weigh the risks and potential benefits of the surgery. Avoiding medical jargon helps the patient to understand the information more easily so they can make an informed decision. Also, the discussion is always tailored to the patient’s specific situation, taking into consideration their health history and the specific type of surgery. 3D spine models or other visual aids in the office are helpful, as well, to describe exactly what will happen during the surgery and what common and rare risks are associated. Lastly, I encourage patients to ask questions and to express concerns or fears. Addressing their concerns ensures that they're comfortable and informed about their decisions.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Every single patient that gets an operation gets a very clear and complete explanation of the attendant risks of surgery. Since each operation is a little different, I tailor the explanations to the type of surgery, the location of it, and the patients' individual scenarios. Every patient has different varieties of questions as well as variable amounts of understanding. It is very important to me that the patients leave that day with all of their questions answered and are feeling as comfortable as possible going into the surgery. I really feel it makes for and prepares for a successful surgery.
Kamran Khan, MD. Endeavor Health Neurosciences Institute (Naperville and Woodridge, Ill.): This is a complex conversation but one that requires a clear and concise method. It is important to communicate to your patients expectations and complications associated with the various operations we do. Remaining empathetic throughout the process and having open-book conversations will help to build the necessary trust in our care of our patients.
Kushagra Verma, MD. DISC Sports & Spine Center (Marina del Rey, Calif.): When it comes to discussing surgical risks with patients, I take an approach of complete transparency and honesty. I like to tell patients what I can do, what I can't do, what my experience is, what the risks are and what the most common complications are. I feel like these are sometimes difficult conversations, but they're very important.
I also see patients often two or three times prior to surgery, and I repeat myself frequently so that they understand all the risks and they've had more than one chance to hear those risks. Any risks are also outlined in our clinic notes and reiterated prior to surgery. I think this gives patients peace of mind, knowing that they are working with a surgeon that is completely honest with them and upfront about the risks of spine surgery.
These days, thankfully, those risks are much lower with advanced surgical techniques, surgical experience, and the innovations in minimally invasive technology. Often we are able to alleviate a patient's symptoms without manipulating the nerves quite so aggressively as we've had to in the past.
One example of how we've made complex spine surgery safer is by utilizing staged approaches for complex spinal deformities. In the past, we would often do pedicle subtraction osteotomies, but more commonly, in my practice, we're doing staged approaches with both an anterior and a posterior approach. This allows for less neurologic risk, less bleeding and an overall easier recovery for patients.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Compulsory and repetitious coverage of surgical details, which includes expectations and risk, are conventional and reiterated throughout the entirety of the process. Unfortunately, this is not usual and customary practice and many patients report leaving another office without clear objectives and adequate comprehension. Granted, the compendium and its routine are quite large and usually daunting, yet the preoperative timelines and multiple checklists will allow for further interaction and inquisition. In all cases, the departing considerations should include understanding and presentiments one may possess before the surgery is undertaken.