What is Elective Spine Surgery?

What is Elective Spine Surgery?

What is Elective Spine Surgery?

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People are often confused by the term Elective Spine Surgery. The most broad definition indicates a choice to pursue surgery.  So let’s try to define it in a way that everyone can understand.  Naturally,  there may be some nuanced differences among some stakeholders of the definition.  We will try to stay within the mainstream of opinions.

Most importantly,  we must define what it is not:

Emergency Spine Surgery:  There are certain situations where Spine Surgery is an emergency.  Thankfully,  those situations are rare.  In general,  Emergency situations are those instances where delay may cause irreversible harm to your body.  Usually,  that situation means more than just pain.  Emergency Spine Surgery situations are associated with nerve or spinal cord compression that needs relief to give the chance of restoration to normal function.  These situations usually involve trauma,  infection,  or cancer.

In terms of Trauma,  it is usually secondary to a broken spine bone,  or a large herniated disk,  or a pre-existing narrowing of the spine (spinal stenosis) with a resulting significant compression of the individual spine nerve,  or the spinal cord.  The emergency is secondary to loss of the function of the nerve,  and specifically,  the ability to control the muscles associated with those nerves,  or the spinal cord itself.   Depending on how rapid the muscle weakness presents,  surgery may be indicated on an emergent basis.  For the arms,  and legs, weakness secondary to disk herniations,  without evidence of abnormal spine movement (spinal instability),  has an option of waiting to see how the nerve responses to the body’s ability to resorb some of the disk herniation.   To Surgeons,  muscle weakness means the inability to control the muscles secondary to nerve impairment,  not weakness secondary to the pain associated with the nerve irritation.  To patients,  there may not be a difference,  but to Surgeons,  there is a very large difference. That is why you need a good neurologic exam to determine if Surgery needs to be performed.

On the other hand,  muscle weakness associated with a disk herniation and  instability,  with present with a constant irritation of the nerve.  Usually decompression and stabilization is the recommendation.

If there is a broken spine bone  (vertebral fracture) with associated instability pattern,  and muscle weakness,   Emergent Spine Surgery is the usual recommendation.

Pain associated with spine infections,  with progression of weakness is also an indication for Emergent Spine Surgery.  It is important to know that some spine infections can be treated without surgery,  as long as there is no evidence of progressive weakness.

Likewise,  cancer causing nerve encroachment can be observed,  and treated with non-surgical means as long as there is no evidence of muscle weakness or loss.

The nerves to the bladder and bowels are very sensitive.  If there is irritation to these nerves,  it can cause inability to control those functions.  Spine Surgeons call this condition Cauda Equina Syndrome.  While the science is still not completely understood,  there is a general consensus that this situation is considered an Emergency Spine Surgery condition.

Please note that PAIN by itself,  is not considered an Emergency Spine Surgery Condition.  I know that is a source of frustration for many patients,  but we do know that Pain can and usually does improve for many patients.  If there is no evidence of any associated weakness,  and no evidence of a cancer or infection that is worsening,  Pain by itself cannot be the only criterion for Emergency Surgery.

So now that we defined the needs for Emergency Spine Surgery,  What is ELECTIVE SPINE SURGERY?

Elective Spine Surgery is usually a choice made by a patient after trying to deal with the situation for some time.  Usually,  there was come and go period of pain,  discomfort,  tingling,  numbness,  without severe muscle loss.  For scoliosis patients,  there has been an observation period with evidence of  progression of the curvature.  For patients with an instability pattern,  there has been a steady increasing nature of the pain.   Despite treatments such as medications,  injections,  and therapy the symptoms have worsened.  For disk herniation patients,  there has been recurrent episodes of severe pain,  with associated dermatomal neurologic findings.

The decision for surgery is not a limb or life threatening one  (that is more of the Emergency Spine Surgery criteria),  but is secondary to a progression of symptoms.  For some,  the progression is manageable.  For some,  secondary to the natural aging process,  the activities restrictions that naturally result (we do slow down as we get older)  are enough to accommodate the underlying spine condition.

For others,  the spinal condition is such that it is isolated to a specific area,  and Elective Spine Surgery can have a significant positive effect on their daily life activities.    The chances that Elective Spine Surgery can improve your life,  with reasonable associated risks need to be explored by the Patient and the Surgeon.

As of now,  in the USA,  if a Patient can demonstrate that they have tried non-surgical options for their spine problem without success,  and the proposed surgery has a reasonable chance of success,  most insurance entities will still consider the Spine Surgery medically necessary and cover the Surgery.  I have had many Patients assume Elective Spine Surgery means it will not be covered by insurance.  That is not true as long as the prior factors have been met.  1.  Failure of reasonable non-surgical options.  2. The Elective Spine Surgery has a predictable favorable chance of success.

The problem,  of course,  is finding out how to meet the two factors,  as each insurance entity continues to define, and refine each factor.

To Summarize,  Elective Spine Surgery is 1. not limb or life threatening  2. offered after failure of reasonable non-surgical treatment 3. has a predictable favorable chance of success.

If you are considering Elective Spine Surgery,  please consider several opinions.  There are always different options for most surgical situations.  I have personally seen recommendations for very large  multiple level disk removals and fusions with cages,  screws,  and plates in situations that I have only recommended a simple removal of a small piece of bone or disk on an outpatient basis.  Remember that Elective Spine Surgery is not Emergent.  I know you are in pain, but take the time to get to know all your options.   Ask the Surgeon what they would do for themselves,  or for their own family in a similar situation.  I would also avoid any Surgeon that guarantees a specific outcome.  

Blog bases on personal opinion of Dr. John Shim with greater than 20 years experience as a spine surgeon.

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Author and Contributor to www.Spine-Health.com – July, 2015

www.Spine-Health.com/author/john-h-shim-md-facs

Chief of Surgery, Mease Countryside and Mease Dunedin Hospitals, Safety Harbor and Dunedin, Florida. 2014-2016.

Orthopaedic Section Chief Mease Countryside Hospital; Safety Harbor, Florida Mease Dunedin Hospital; Dunedin, Florida.2008-2013

Board Member Morton Plant Mease Research Council

Co-Director of Mease Neuro-Ortho Spine Center Mease Dunedin Hospital; Dunedin, Florida.

One of “6 Spine Physicians Ranked #1 on Google” – December 2016

Top Ten Most Liked Spine Surgeons on the Internet – July 2016

2016 Spine Surgeons to Know list – January 2016

2014 Spine Specialists to know list – September 2014

One of Ten Leaders of Certified Spine Programs – December 2011

 

The Best Orthopedics in Tampa

The information provided on this website does not provide or should be considered medical advice. It is not a substitute for diagnosis or treatment of any condition. The information provided is for informational purposes only. You should not rely solely on the information provided on this website in making a decision to pursue a specific treatment or advice. You should consult directly with a professional healthcare provider.

As a condition of using the information on this website, ShimSpine and its physicians are not responsible for any advice, diagnosis, treatment or outcome you may obtain.

ShimSpine.com is completely self-funded. No outside funds are accepted or used. This website does not utilize paid advertising as a source of revenue.
Outpatient Spine Surgery Considerations. www.Spine-Health.com. January 2016.

What is Spinal Stenosis? www.Spine-Health.com. October 2015.

Surgeon insights on the Changing Landscape of Orthopedic Care. OrthopedicToday. June 2014

Chapter 33: Interspinous Spacers. Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

Chapter 35: Minimally Invasive Percutaneous Lumbar Fusion Technique.Shim JH, Mazza JS, Kim DH Published in Minimally Invasive Percutaneous Spinal Techniques. Elsevier Health Sciences, Philadelphia, Pennsylvania. (Published 2011)

March 2010 Minimally Invasive Transforaminal Lumbar Interbody Fusion American Academy of Orthopaedic Surgeons Annual Meeting New Orleans, Louisiana February 2010

February 2010 A Review of Dynamic Stabilization in the Lumbar Spine Selby Spine Symposium; Park City, Utah

November 2009 Lumbar Spinal Stenosis Community Based Lecture; Tampa, Florida

September 2009 Instructor/Proctor Minimally Invasive Lumbar Cadaver Lab; Tampa, Florida

February 2009 New Spinal Technology: Cervical Disc Replacement and Interspinous Spacers. Selby Spine Symposium; Park City, Utah

February 2008 The Degenerative Spine: The Role of Dynamic Lumbar Stablization and Interspinous Spacers Selby Spine Symposium; Park City, Utah

October 2008 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

September 2007 Emerging Technology in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

October 2006 Emerging Technology and Techniques in Spinal Surgery Orthopaedics in the 21st Century Symposium; Morton Plant Mease Healthcare; Largo, Florida

May 2005 The Role of Kyphoplasty in the Treatment of Vertebral Compression Fractures Mease Neurosciences Symposium; Clearwater, Florida
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