Friday, March 13, 2015

Looking into the Future: My Spine Surgery


I have moderate scoliosis, a curvature of the spine. Fortunately for me, my curve is S-shaped and both curves are balanced. This means that I stand upright, my movement and everyday life is not affected (aside from back pain) and you wouldn’t be able to tell that I have the condition if you saw me out buying a coffee. However others with scoliosis are not so lucky and surgery is an unavoidable path that they must trudge, in order to improve their quality of life.

But what does spine surgery look like? Many surgeries involve fusing the vertebrae of the spine around the area affected, or inserting rods and screws, as seen in Figure 1. Surgeries are highly invasive and can require extensive recovery periods, with original flexibility near impossible to regain in some cases.



Fig 1. University of Utah Hospital, Radiology Department. X-ray of U.S. girl, age 16 years 10 months, with post-operative scoliosis. Front, standing, clothed. 5 February 2010. X-Ray Image. Wikimedia Commons. Web. 12 Mar. 2015.




Is this all we can hope for? Will I need to have my back completely split open, my spine melted together or drilled into, them stitched back together? Quite the dramatization but I like to think that the answer to this question is no. With the advances in medical science, I would like to expect technology to advance in leaps and bounds across all areas, including spinal surgery.

Aside from the fact that currently a person’s main supportive skeletal structure can be morphologically changed without them falling apart (pretty incredible as it is), evidence of surgical development can be seen already. An Internet search will lead you to the Bonati Institute, which proudly claims to be the “1st U.S. FDA-Approved Laser Assisted Spine Procedures” as of 1991. Laser technique allows for less invasive surgery, claiming to avoid the open spine aspect and offer a much quicker recovery time.

Dig a little deeper and you will find even more enticing and promising publications. For example Waleed A. Alsunbul et al. recently published a paper discussing the use of an inflatable device to extend the spine appropriately during cervical surgery (2014). This device would improve on previous techniques used which are often inadequate in situations when components need to have their position adjusted mid-surgery (Alsunbul et al., 2014). While this device is newly proposed and has yet to infiltrate mainstream surgical practices, it is evidence that the tools used for spine surgery are continually being improved.

Beyond the physical realm of surgery, there are the psychological effects that come with a radical post-operative change in posture and quality of life. This is an area that I do not think many (including myself) would consider initially; it is logical to think that when the structural issue is fixed, the pain and discomfort will be alleviated also. However it is a known phenomenon that surgical success does not always result in a perceived success for the patient. It turns out that there are psychological factors at work.

Jake Epker and Andrew Block have suggested that screening patients to assess psychological status before spine surgery can help to reduce “failed” surgeries (2014). These results can help to guide patient support and recovery after surgery, to cater to individual psychological needs as well as nurturing the body back to full health. Studies such as Epker and Block’s are important for the development of the field of spine surgery as they prompt the use of a wider lens to view what would appear to be a mono-dimensional, purely physical problem.

I make no claim to be an expert in the area of spine surgery. Much of what I know stems from my personal experience of regular consultations with a scoliosis specialist, discussions with a relative who performs spine surgeries (what a coincidence!) and curiosity-fuelled Google searches. I may not be an expert but I am very involved, biologically even. And I like what I see. Progress is being made and will continue to be made over the coming years and decades.

Perhaps when I need my spine fixed, the surgical techniques of today will be entirely antiquated. I wonder, what’s next?


Alsunbul, Waleed A., et al. "Inflatable Device for Intraoperative Control Extension in Cervical Spine Surgery." The Canadian Journal of Neurological Sciences / Le Journal Canadien Des Sciences Neurologiques 41.2 (2014): 293-5. Print.

Epker, Jake, and Andrew R. Block. "Psychological Screening before Spine Surgery: Avoiding Failed Surgery Syndrome." Psychological Injury and Law 7.4 (2014): 317-24. Print.

For more information on the Bonati Institute:

http://www.bonati.com

12 comments:

  1. The innovations in spinal surgery seem promising and have hope for a better future for those with scoliosis. However, a question that came to mind was, even if the laser surgery for example is less invasive, are the post-surgery effects still similar? Would someone with laser surgery be able to gain back more flexibility than those with invasive surgery? Possibly. Perhaps advances in physical therapy need to occur along side advances in spinal surgery.

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  2. This is a really interesting topic and its future is exciting. It is obvious that there needs to be much more research and proven results from clinical trials. Some things that I am curious about are: How many/what kinds of people does this affect in the general population? And what would you prioritize in going through with a surgery: achieving better visual appearance of your spine, better flexibility, or less back pain?

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  3. The personal story associated with this blog post made this entry especially fascinating. I knew very little about scoliosis and spinal surgery prior to reading. The psychological effects of spinal surgery were interesting as well because they were something I had never considered before. It goes to show that there are many aspects that doctors and patients need to consider before undergoing surgery.

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    1. I agree with Megan in that your personal experience really enhances this research's significance. I always thought that psychological complications of surgery would mostly dictate recovery time, not the perceived success level of the treatment itself. Additionally, as innovations like robotic surgery become commonplace, I wonder if the psychological dangers will be mitigated.

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  4. The ability to transform a structural aspect of the human body with a minimally invasive surgery makes me wonder if we can live in a future without surgery. I understand that is unlikely; however, I feel as thought physicians are trying to transition to less invasive surgeries or laser-based surgeries. When I shadowed a surgeon, he performed a minimally-invasive surgery and completed all of his major tasks by looking at a video of the inside of his patient. With that in mind, I wonder how many different surgeries are/ can become minimally invasive?

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  5. The ability to transform a structural aspect of the human body with a minimally invasive surgery makes me wonder if we can live in a future without surgery. I understand that is unlikely; however, I feel as thought physicians are trying to transition to less invasive surgeries or laser-based surgeries. When I shadowed a surgeon, he performed a minimally-invasive surgery and completed all of his major tasks by looking at a video of the inside of his patient. With that in mind, I wonder how many different surgeries are/ can become minimally invasive?

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  6. This is a really optimistic post, and it makes me happy that there is significant progress being made in the field of spinal surgery! I was particularly interested in how they would screen patients in order to reduce failed surgeries. If they could do this for spinal surgery, would it be possible to screen for other orthopedic surgeries?

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  7. Very interesting post! It is comforting to read all about the progress being made in this field! Additionally the personalization factor through screening the patient for their psychological status before surgery seems like an amazing idea. I think this will allow the patient to additionally develop trust knowing that after their surgery they will be catered to not only their physical recovery but additionally their psychological recovery.

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  8. This post was very interesting to me because I grew up with a kid that developed a tumor on his back in 6th grade. Since then, he has had over a dozen spine surgeries (and is unfortunately still having them). These surgeries have been extremely invasive and have caused him to miss months of school at a time and be confined to a wheelchair for months after them. The idea of minimally invasive spine surgery is very exciting for people like him who suffer chronic back problems.

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  9. Great post! I wonder how prevalent this disease is and how severe it can be. I might end up googling some images to see. It is awesome to see progress being made, I cannot imagine having to live with a crooked spine. It is also awesome to know that there is great hope for those who do and that it is not stopping you from being so active!

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  10. This was a very intriguing post! My dad has scoliosis and as a kid they highly recommended surgery, however, he didn't want to have to deal with the extensive recovery and cumbersome brace and opted not to have the surgery. Now later in life he is still feeling the effects of this decision, but had these new options been available perhaps things would be different.

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  11. This blog post made me extremely happy. The progress in spinal surgery seems tremendous over the past few years. I hope this upward trends remains this way in the near future.

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