Spine surgeons often depend on the "art of medicine" to treat their patients. They rely on their experience, knowledge and expertise to diagnose and treat a variety of spine conditions and back pain issues. However, healthcare is moving toward evidence-based medicine and there may not be as much room for interpretation in the future.
"Our diagnosis and treatment methods have to become more scientific and objective," says Lawrence G. Lenke, MD, surgeon-in-chief at The Spine Hospital at NewYork-Presbyterian/Allen and co-director of the adult pediatric comprehensive spine fellowship. "We're headed in that direction and when we've developed treatment protocols and pathways that will have more consistent outcomes. Right now treatment for many spine conditions is still highly variable, but hopefully in the future we can become more consistent and achieve better outcomes with fewer complications. The more objectivity and science behind it, the better."
There are several preoperative factors to consider when diagnosing a patient and deciding on treatment. These factors include:
• Radiographic and neuroimaging
• Comorbidities
• Bone density
• Psychological and physiological assessments
Focusing on data from these areas can help guide physicians and patients to treatment with a high probability of success. Surgeons can see who is likely to benefit from the surgery and who isn't a good candidate. The data from a single center is important, showing how a particular patient does based on the surgeon's skill, but multicenter data can be even more beneficial to track trends.
"In the future we'll see much more standardized patient care," says Dr. Lenke. "We'll be able to develop an algorithm to show the patient their likelihood of success."
For example, the algorithm could create categories for patients: Green, Yellow and Red. The Green patients are considered good candidates for surgery; Yellow patients may need extra steps before surgery such as weight loss or conservative measures; and Red patients shouldn't have surgery because predictive analytics show there is a high complication rate and/or a very small chance of a favorable outcome.
Surgeons can also lead the charge to decrease infection and complication risk in the operating room. "Right now the surgeon is the captain of the ship, but we have a lot of ship mates," says Dr. Lenke. "The team approach is very important. The entire perioperative team should be dedicated to taking care of patients."
The keys to reducing complications while managing surgical spine patients include:
1. Developing preoperative teaching methods to make sure the patients understand expectations before surgery. In addition, they should understand facts about discharge and what they need when they return home prior to coming to the hospital for their surgery.
2. Involve the family in postoperative discussions so they can support the patient through the entire recovery period.
3. Developing specialized care models postoperative such that the entire healthcare team including the nurses, therapists, nutritionists, social workers etc., are all experts on spine surgery patients.
"We are seeing that a unique nursing unit just dedicated for spine surgery patients can really lower our complication rates," says Dr. Lenke. "In our Spine Hospital, there is a postoperative nursing unit that is just focused on spine care and all of the therapists and ancillary personnel are dedicated to spine patients. Because of their experience and expertise, they are really passionate about it, and that makes a difference."