Spine surgery, in general, should be considered a last resort, after failure of all forms of conservative options (medicines, physical therapy, injections, and neuro-psychologic evaluation).
Fusion surgery is typically recommended to stabilize unstable vertebral body segments during surgical decompression around the nerves and thecal sac (protective membrane around spine). I recommend fusion surgery in the setting of instability and when I feel that decompression alone will not be adequate, or that I might increase a patient’s stability.
Fusion surgery has changed dramatically even since I have finished my fellowship training. The technology of the implants we are using has increased the surface areas for fusion, which has increased the ratesof fusion, and thus, improved a patient’s outcome.The biologics (medicinal product that is created from a living organism) also continue to evolve and have dramatically increased our rates of fusion as well.Consequently, we do not have to harvest bone from a patient’s hip as frequently.
My specialized training from my spine fellowship has been vital in treating spine pathologies. Whether spine surgery is performed by an orthopedic surgeon or a neurosurgeon, they should be fellowship trained. Fellowship status is the highest level of training and is a necessary step a surgeon
should take in order to improve the chances of better outcomes for their patient.
In my training, I was fortunate to be taught several important principles:
1. Not everyone needs or can benefit from spine surgery.
2. For a long time, spine surgery had a bad reputation because either the procedures performed were not the correct ones to treat the patient’s pathology or we did not have the appropriate technology. Now that we have made tremendous strides with our technology, we have the technological support to perform the correct operation for the patient.
3. It is fundamentally important to offer the right surgery that will address the patient’s specific pathology, and in doing so, dramatically improve
the patient’s outcome.

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