Written by Heather Linder | Monday, 03 February 2014 13:54
This is part three of a three-part series on spine surgeons discussing spinal revision surgery and efforts to avoid failed back surgery syndrome.
Scott Spann, MD, is the founder of Westlake Orthopaedics Spine & Sport in Austin, Texas, and one of the initial founders of Westlake Hospital. In 2007 he founded Pantheon Spinal to manufacture spine surgery implants. He served his orthopedic residency at Ochsner Foundation in New Orleans and his spine surgery fellowship in Atlanta.
Here Dr. Spann discusses potential causes of failed spine surgeries and how patient expectations and technology come into play when embarking on revision surgery.
Question: What is failed spinal surgery and why does it occur?
Dr. Scott Spann: A diagnosis of failed spine surgery is most commonly found in a patient who has previously undergone surgery in the area of the lumbar spine and has a less than acceptable result. Similar issues can also occur in the cervical spine. During the initial surgery, decompression may have been inadequate or stabilization may have been needed and not performed or a combination of the two. Hypertrophic scar tissue is an arguable pathologic entity as well. Underlying metabolic factors may play a role in patient populations including diabetics, smokers, those with autoimmune diseases, those with poor vascularity and those taking medication that inhibit creeping substitution.
Prior to surgery, I like to focus the discussion on reasonable postoperative expectations, both short and long term. If there is a significant mismatching of expectations, no matter how well the procedure is performed, you may still have an unhappy patient. As long as the communication is there and the patient understands what you are trying to do for them, by and large, they will be happy.
With unrealistic expectations, satisfactory results will never be met. We need to be realistic with our patients.
Q: When someone comes in needing revision surgery, what is the first thing you must do?
SS: The first task is to prepare the patient. There is an art to what we do; each patient is different. If someone has undergone a major spinal procedure and perceives an unsatisfactory outcome, then any consideration of revision surgery is a very psychological daunting challenge for the patient. As surgeons, we must establish a relationship with the patient that creates an optimistic outlook for their future well-being. Many times patients also need to understand an increasing role in their own recovery. This can be a challenging task for both the patient and the surgeon.
Philosophically, I believe that what we do as spine surgeons is probably one of the most singularly intimate acts that occur amongst humans. We may have a limited initial interaction with patients, particularly in the event of previous attempted forms of management carried out by another physician. The patient may simply be seeking a surgical solution. In those pre-surgical visits, they are evaluating us as much as we are evaluating them. In effect, they are deciding if we are the best choice to cede total control of their body and potentially their neurological function. I can’t think of anything that is more intimate a scenario than that.
Q: Is technology helping to reduce spine surgery failures?
SS: I absolutely think advancements in technology are what have kept us at the top with the best medical care in the history of the world. At some level there has also been a financial motivation. If we don’t have the motivation for corporations to willingly undertake the risks to achieve those technological advances, then I don’t know how they will ever continue to progress.
Q: Can spine community as a whole do anything about issue?
SS: Revision surgery is much harder and is much more expensive than the initial surgery. It is more difficult for everyone involved. There are many motivations to minimize this occurrence. I do think that the efforts made toward education and maintaining technological advancements are the best possible solutions for us to maximize outcomes.
In conclusion, maximizing technology, creating a well-informed patient relative to appropriate surgical outcomes, selecting the proper procedure for the proper diagnosis and performing the most technologically accurate operation possible will advance our efforts to eliminate failed back syndrome.