Many seasoned spine surgeons have habits and practices that they left behind from their early years in the field.
Three spine surgeons share their recommendations for early career spine surgeons to avoid those same habits.
Next question: What are the policy issues you're advocating for in your job?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Sept. 18.
Editor's note: Responses were lightly edited for clarity and length.
Question: Is there anything you did at the start of your career that you wouldn't recommend early-career spine surgeons do now?
Rachel Bratescu, MD. George Washington University (Washington, D.C.): As an early career spine surgeon myself, there are certain pitfalls I am actively trying to avoid at the advice of my mentors. First, placing too much emphasis on imaging and not enough on history and physical exam. We have access to a variety of imaging modalities and it is easy to formulate a surgical plan based on imaging findings alone, without regard for the severity of patient symptoms, correlation or examination findings. Imaging should be used as an adjunctive tool and not the primary driver of treatment. A second example is restricting your practice too early. When building a patient base it is most beneficial to see and treat a variety of pathologies and focus on building a niche further along in your career. This process can often happen organically, be driven by practice setting or personal interest.
Kushagra Verma, MD. DISC Sports & Spine Center's Marina del Rey (Calif.) ASC: When I started my career, I had an interest in scoliosis and complex spine surgery, and I didn't do a lot of minimally invasive surgery. Gradually, over the years, I learned the value of utilizing smaller incisions and microsurgical techniques to deliver higher patient satisfaction, smaller incisions, quicker recoveries and equivalent surgical outcomes. These days, a majority of our one- and two-level problems are managed with minimally invasive techniques, and the recovery periods are often so short that patients are going home the same day or the next day. For complex spine cases, the recoveries are often longer and more difficult, but we've become adept at doing the surgeries more quickly, with less blood loss and in some situations utilizing a two-surgeon approach.
In my career, I started by doing complex spine surgery and then gradually evolved to becoming a minimally invasive surgeon as well. I would probably recommend surgeons do the opposite in their careers: master minimally invasive surgery, and gradually approach more and more complex pathology.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Pressing a training bias or dogmatic approach to the spine removes the individualism from the patient and the treatment options available to the populace as an assessed singular entity. Aggressive spinal surgery is no longer acceptable in my estimation and persists without much comprehension or regard for long-term outcome. The collective we have to be more discerning and personal is decision-making and implementation. Radiographic assurance is not purely patient outcome success.