It’s a great time to be a spine surgeon, and it’s an even better time to be a spine surgery patient! We all know people who had back surgery decades ago and we hear their stories of how enormous and traumatic it was. Just about every type of spine surgery has improved over time. When we say improvement, the most important measurement is outcomes – patients do better in 2019 than they did in 1979! The other major improvement is the amount of pain and convalescence involved for the patient which is a fraction of what it used to be. But let’s do a deep dive into why spine surgery is on a continuous path of improvement and why someone’s experience with surgery many years ago should not influence your decision to elect to have surgery.
Here are five ways that spine surgery has improved since I started performing surgery:
Less invasive techniques – By far the biggest improvement is the emergence of surgical technology that allows surgeons to make extremely small incisions and do not require disrupting the surrounding muscles, tendons and nerves. It’s also easier than ever to get to the area for the surgical correction. This is much less painful for the patient afterwards and significantly decreases recovery time. Many of the most common spine surgeries which greatly improve quality of life such as discectomies or surgeries for stenosis are done with minimally invasive techniques.
Better pain management – In the mid 90’s the American Medical Association declared pain the fifth vital sign. This meant doctors looked at pain differently and a new focus was placed on pain management which blossomed into a robust medical discipline. This recognized patients with chronic pain and spurred discovery of new solutions. As a surgeon this meant there were options of new medications to help manage pain as well as an alliance with professions like physical therapy that all helped patients suffer less. It also meant that surgeons learned how not to over-prescribe and to have a healthy respect for medications that are sometimes medically necessary but carry a serious risk of addiction. There are dozens, possibly hundreds more over the counter options than there were 20 years ago but most importantly there is a deep comprehensive understanding of the pathology of pain which all surgeons now incorporate into their treatment plans.
Superb surgical navigation – The technology used in the operating room is simply staggering compared to what was standard back when I was in medical school. We have spectacular imaging prior to surgery telling us exactly what is happening with anatomy and causing the problem, and now we have intra-operative MRI and CT technology that update the imaging in real time allowing us to locate precise points. We can get to places in your body that are unthinkable without destroying everything along the way. This is one of the most exciting advances and its made scores of operations possible and made surgical candidates our of patients who would have had no hope of relief 20 years ago.
Better infection control – Since surgery started in early medicine, infection has been an omnipresent and life threatening risk. Every surgeon will experience incidental infection with a patient at some point in their career. Most infections that are a bi product of spine surgery today are easily treated. They are annoying and uncomfortable, but with vigilant attention to factors that contribute to infection in the operating room and the use of post-operative prophylactic antibiotics they are very uncommon.
Decades of data – Medicine is self-correcting. Doctors are constantly evaluating what works, identifying trends and using that analysis to refine surgical protocols. Big health data has taught us what works best, and that means better surgical plans and better outcomes.
If you are a candidate for spine surgery, or you are watching or helping a loved one decide, use this discussion to dispel any fears or hesitation. Make the decision for surgery based on your doctor’s prognosis while resting assured that when it comes to safety and efficacy, it’s a GREAT time to have back surgery!