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Will I Need Another Spine Surgery?

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Jeffrey R. Carlson, MD

As a fellowship trained spine surgeon, I see patients every day that have had spine surgery in the past but who are again facing worsening pain and dysfunction.  When they had their initial surgery, they were told that this procedure would correct their current problem for a time, but they should expect to have more surgery in the future. This seems like a bleak outcome from what should be an otherwise successful endeavor. Most of the time, these patients have limited their activities, lifestyles and vocations in an attempt to prevent the presumed automatic need for another surgery.  They come seeking my opinion, often frustrated by their previous surgical experience. 

As we have developed better surgical methods in most other types of surgery (i.e. using a scope to remove a gallbladder) that have led to improved outcomes and less post-operative pain, it seems that some older spine surgeons have neither adapted nor improved their methods for the best long-term patient outcomes.  As an innovator in spine surgery, I’ve been able to add surgical techniques in cervical and lumbar spine surgery that can often eliminate the need for further surgery.  We are developing less invasive surgical techniques that don’t cause injury to other spinal segments and don’t disturb spinal discs unnecessarily. 

A recent study from John’s Hopkins University was presented at the Scoliosis Research Society that expounds on this improvement.  These researchers were able to evaluate the standard open surgical techniques that are being used by most spine surgeons and compared this to a minimally invasive technique used by more advanced surgeons.  They had noted in their practice that there was a 30% chance that those who had open surgery would lead to another spinal disc problem.  They were able to review their minimally invasive spine surgery patients and found only 6.7% of these patients had another surgery.  This stark difference in outcome seemed to be solely related to the surgical technique employed.

Using a minimally invasive technique that does not disrupt the tissues above or below a fusion level was able to drastically reduce the need for further surgery.  These techniques also allow us to reduce the patients’ post-operative pain, allowing most to go home on the day of the surgery.  The goal of minimally invasive surgery is to decrease the disruption from the surgery itself, by fixing the problem area and not disrupting the tissues in normal areas.

These techniques should also decrease the time in the operating room, which also lessens the chance of a complication from surgery or anesthesia.  Minimally invasive surgery is not just about making small incisions, but also involves preserving the healthy tissue that allows the body’s own muscles, soft-tissues, bones and discs to continue functioning normally.  Less invasive surgery should cause less pain and decrease or eliminate the need for further surgery and allow the patient to return to their usual work and life activities very quickly.

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