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What is Spine Surgery Expertise?

Some Patients want to have surgery by a specific spine surgeon. But, do patients really understand why? From what I can tell, patients want to see the spine surgeon that had cured a friend or relative. They seek out the spine surgeon that has the reputation of “being good”.

Some equate spine surgery excellence to pure technical skill. In other words, the ability to perform a certain technical task such as removing a particular disk, fusing a particular level, or implanting a certain device. I agree that some surgeons have better reputations in those areas. Ask your local operating room nurses and operating room staff. They definitely have certain surgeons in mind when it comes to surgery for their own family.

For certain surgical specialties, technical skills are all that matters. For instance, there are certain surgeons that have world class reputations for removing parathyroid glands. In that situation, the determination for surgery has already been made by the others. The surgeon has a pure technical goal.  Their bedside manner,  and office style does not matter.  In certain surgical specialties,  it is about achieving the  anatomic goal.

SurgeonsBut, in my opinion, Spine Surgical Expertise is more than the technical skill. The factors that contribute to the recommendation of spine surgery, and the types of spine surgery are just as important. To give you an example, in most communities, there are at least a few spine surgeons who almost always perform a fusion operation on every lumbar disk or lumbar stenosis patient. These Surgeons have good technical skills, and often, their post operative x-rays and results are acceptable. But, I know that the same or better results could have been achieved by a much simpler discectomy or laminectomy procedure without the fusion. Unfortunately, with the fusion operation, the rates of complications including infection, persistent pain, and satisfaction is less than the simpler procedure. In addition, the costs to the patient, or to the Healthcare System are much higher in the fusion population. Yet, to these fusion oriented surgeons, every disk or stenotic finding can only be improved with fusion. If the results are acceptable, it is hard to argue against the decision to almost always fuse a patient. But, we must define “acceptable”.

In my opinion, “acceptable” requires examination of the many factors that determine a successful outcome. In the modern era of medicine, we must factor in age, other medical conditions, weight, prior surgeries, and the exact cause of the complaints. Then, if there is a potential for a surgical solution, we must also gauge the expectations of the patient. On top of that, we must also factor in the post-operative phase, including the area of recovery, the level of family support, and the financial strain of surgery and recovery. With each spine finding, there may be multiple ways to correct the situation. But the best option will be determined by weighing all the factors above. Time must be spent to identify and weigh all these factors.  Every nail does not need a hammer.  Counseling is tantamount to the optimal result and patient satisfaction.

In my opinion, most Spine Surgeons possess the technical skills to perform the operation. But, the Best Spine Surgeons also possess great judgment on when to offer surgery, which surgery to offer, and when not to offer surgery. The Best Spine Surgeons will take the time to identified the nuanced needs of each patient. While the operating Room Staff can tell you who possesses great technical skills, ultimately, Spine Surgery Expertise also come down to experience, knowledge and judgement.

The quality of Judgement is in my opinion, just as, or is more important technical skill.  As a patient,  you should be tactful,  but,  in the end,  you should be confident in your chosen Surgeon.  Confirm in your mind that your Surgeon not only has great technical skills,  but also has great surgical  judgement.

Last modified: October 22, 2019