Eight spine and neurosurgeons outline how they can partner with other specialists to benefit patient care.
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. We invite all spine surgeon and specialist responses.
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Note: The following responses were edited for length and clarity.
Question: How can spine surgeons partner with surgeons of other specialties to benefit patient care?
Ram Mudiyam, MD. Hoag Orthopedic Institute (Irvine, Calif.): A key area of collaboration is having an experienced vascular access surgeon when performing anterior spinal surgery in the thoracic and lumbar regions. This is especially true in difficult revision cases where vascular and other retroperitoneal anatomy is often distorted due to adhesions from prior surgery. Other key specialties that spine surgeons routinely collaborate with are infectious diseases as well as pediatric and adult intensive care.
James Chappuis, MD. Spine Center Atlanta: The most important partnership for my surgeries is working with a general access surgeon for anterior lumbar interbody fusions. This is because it's still one of the best fusion procedures with the best outcomes for one-level lumbar spine problems in my opinion. Having a good access surgeon is critical to the success of that procedure. Also critical for a spine surgeon like me who sees failed spine surgery cases is to have a strong partnership with an interventional spine physician. Firstly, this is to ensure the patient has failed all forms of conservative care before considering surgery and secondly, to help diagnose the pain generator or generators.
Spine Center Atlanta has a full time interventional spine surgeon, Dr. Brian Adams. Additionally, it is important to have a good working relationship with an extremity orthopedic surgeon, which we also have at the practice, Dr. Brett Rosenberg. This is because patients will often have injuries to their spine and to their extremities. Therefore, they can all be treated in one place.
Brian Adams, MD. Spine Center Atlanta: As specialists, we tend to delve deeply into care of one specific system, but it is of paramount importance to view the patient as a whole. It is essential for specialists to have a good working relationship with other members of the care team. As an interventional spine physician, I have to have absolute confidence in surgeons that I refer my patients to. I found that a private practice model with a collaborative effort between interventional spine physicians and spine surgeons working under one roof provides the most comprehensive patient care. I can collaborate face to face on a daily basis with my surgeon colleagues.
Brian R. Gantwerker, MD. Craniospinal Center of Los Angeles: Partnerships are a difficult venture, but I think there are certain reciprocal relationships that can really help patients move through the system. Partnering with a reputable pain doctor that has a similar patient care philosophy is helpful and allows for seamless continuity after surgery. Solid relationships with vascular surgeons and oncological surgeons make sense, especially if you are looking to grow an anterior or oncological practice. One should be able to also give a name of a good surgical referral off the top of your head, so patients come to see you not just as a technician, but as a resource.
William Ares, MD. NorthShore Orthopaedic & Spine Institute (Skokie, Evanston, and Lincolnshire, Ill.): Multispecialty groups, or dedicated spine and joint hospitals like ours, can help alleviate diagnostic uncertainty by allowing for the input of multiple specialties when dealing with pathologies that can exist in overlapping bodily regions. For example, an established relationship with, and the immediate availability of, an upper extremity orthopedic surgeon can help facilitate diagnostic uncertainty when diagnosing disorders of the cervical spine. These established relationships can lead to prompt referrals that can help patients be seen by the right provider in an expeditious manner.
Issada Thongtrangan, MD. Microspine (Phoenix): Partnering with surgeons in other specialties will benefit patients. For example, the cardiothoracic surgeon or vascular surgeon will be a co-surgeon for an anterior lumbar interbody fusion procedure. I also refer patients to an ENT surgeon to evaluate whether the recurrent laryngeal nerve is compromised from prior cervical surgery as this information will help me determine what side of approach is safer. Sometimes I asked them to scrub in the difficult cervical cases. This partnering can significantly prevent and reduce known intraoperative and postoperative complications.
William Taylor, MD. University of California San Diego Health System: The most immediate opportunity we found is to organize case conferences. Treatment planning then involves physical therapy, pain services, anesthesia, preoperative services and postoperative planning. These can be organized around specific disease processes, spine centers or individual providers. We found this to be an excellent way to attract appropriate patients, develop care pathways, manage expenses and provide services.
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgeons most frequently partner with general, vascular, or thoracic surgeons for anterior lumbar or thoracic access to spine since they are more knowledgeable with that anatomy and can handle potential complications better. This makes complex spine surgeries safer and more efficient for the patients. I also work closely with urologists when patients have postoperative urinary retention. I work with vascular surgeons to help patients that have both spinal and arterial stenosis as well as to help handle pulmonary embolism risks with vena cava filters in patients that are prone to blood clots.