Spine surgery is not something a physician can always do alone. Often spine surgeons will team up with physicians across specialties before, during and after a case.
Three spine surgeons share the collaborative opportunities they leverage.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
Next week's question: What's the best lesson you've learned from a spine surgeon younger than you?
Please send responses to Carly Behm at email@example.com by 5 p.m. CDT Wednesday, Nov. 1.
Editor's note: Responses were lightly edited for clarity and length.
Question: What opportunities should spine surgeons take to collaborate with other specialties?
Hansen Bow, MD, PhD. UCI Health (South Orange, Calif.): Collaboration is essential for a successful outcome in spine surgery. In addition to collaboration within members of the spine surgery team taking care of the patient, collaboration with other medical and surgical specialties are just as critical. Prior to an operation, consultation with an endocrinologist may be helpful to optimize bone strength in patients who are osteoporotic and in need of a fusion operation. Additionally, interventional pain can assist in helping to diagnose and treat causes of pain. During an operation, ENT, thoracic, general and vascular surgery could help in the approach for an anterior operation.
For almost every patient with spinal oncology, a team is needed to coordinate care. The medical oncologist is frequently the primary medical contact for the patient and may have insights into whether a cancer has a better prognosis due to recent advancements in targeted therapy. Advancements in radiation oncology in the past two decades have enabled surgeries that are safer and require less recovery time (i.e. separation surgery) to be similarly effective to aggressive surgeries for metastatic cancer. Similarly, neurointerventional proceduralists may be able to embolize tumors resulting in less blood loss during surgery. Recent publications have advocated for plastic surgery closure of surgeries for spinal oncology, as they result in fewer postoperative wound complications. Additionally, plastic surgery may be able to provide vascularized corpectomy autografts in situations where pseudoarthrosis is a high concern. Lastly, the two-surgeon model with a neurosurgeon and an orthopedic spine surgeon, especially for more challenging cases, has been shown to result in better outcomes.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Cross-specialty collaboration is a critical aspect of any successful surgeon. I work with several other disciplines in a cross-collaborative manner that is for the betterment of patient care. For instance, my approach surgeon for my ALIFs and lumbar arthroplasty is a consummate professional. We trade ideas on business, medical advocacy and curbside each other when needed. Pain management is also absolutely critical to keep tabs on how patients are doing outside of one’s own bubble. So every opportunity you can get, take it. Medical specialties are also critical, especially with co-management perioperatively, especially as some of our patients age and become more medically complex — especially when so many are trying to offload this to scales and guidelines.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): For decades, collaboration between medical/surgical specialties have been integrated to provide "best practice" to patients, and most complex spinal surgeons currently utilize the many available adjuncts routinely. For instance, complex anterior spinal procedures are best managed with co-surgeons and intraoperative spinal cord monitoring enhances patient safety with Neurology colleague oversight. Integration of multifaceted specialty care is a mainstay of secure healthcare delivery and will continue.
Henceforth, telemedicine and its expanding use in clinical and surgical therapies prospectively provides additional opportunity for collaborative discussion and integrated critical appraisals.