What Would You Ask a Surgeon? Also, No Visitors?!

[Tina_R]

Ed...

To me, the top factors that probably makes a difference between a good outcome and a bad outcome, is where the surgeon was trained and what you hear/read from previous patients. Find someone who did a complex spine fellowship and read as many reviews as possible. (When reading reviews, look for those that talk about good and bad outcomes.
Ignore the ones that complain about things like having to wait 3 hours to be seen, what mood someone was in, etc. Those things are unimportant in the long run.)

--Linda

Linda, what do you think is missing if the surgeon didn't go through a complex spine fellowship? What has a greater chance of going wrong without that training? Or what do fellowship-trained surgeons do better? Does that program turn out neurosurgeons as well as orthopedic surgeons?

Really useful reviews of doctors are small in number.

[titaniumed]

Ed...

I totally disagree with many of your questions. What are you going to do with all the information about the products that your surgeon uses, or the procedures they think are best for your case? As patients, we cannot possibly know what constitutes good or bad selections. Not even me. Even if you find that two opinions are entirely different. How are you ever going to know what is right IN YOUR OWN CASE? Instead of asking questions like that, spend your time listening to your caretakers, asking questions about what to expect for your surgery and recovery, and then use that information to make your decision.

I understand but I think that most people are concerned with what they put in their bodies....that includes spinal hardware.

And your right, we are not going to know if it's a good or bad selection so you ask and let the surgeon explain why. I had a hardware switch and a surgical method changed and of course all of this was discussed. Things got complicated because I waited too long. Sort of like ignoring cancer. It might not be an emergency, but there is a right time and a wrong time to have surgery.

Having 2 different opinions is a problem. One might think that a highly invasive open procedure is too extreme, but then how do you know if a minimally invasive procedure is going to address everything? This was something on my plate. Minimally invasive procedures were probably not as developed as they are today....13 years has passed. Tough decisions that involved a lot of trust in my surgeon's expertise. To build on that trust takes some communicating.

Recovery questions I would think would be automatic....How could one not ask what one is going to go through?

I forgot sock installers, log rolling, and walkers. I knew I was forgetting things. I don't use sock installers or walkers anymore. I will admit that clipping my toenails requires that long stretch....it's not easy being fused up to T2. But, it can be done.

Ed

[titaniumed]

Ed...
To me, the top factors that probably makes a difference between a good outcome and a bad outcome, is where the surgeon was trained and what you hear/read from previous patients. Find someone who did a complex spine fellowship and read as many reviews as possible. (When reading reviews, look for those that talk about good and bad outcomes.
Ignore the ones that complain about things like having to wait 3 hours to be seen, what mood someone was in, etc. Those things are unimportant in the long run.)

--Linda

This was probably my very first question....where were you trained? (and didn't mention it in my post above) and of course I knew all about TCSC and SRS for a long time. I also asked where my 2nd scoliosis surgeon was trained. I know a non scoliosis patient who knew who Dr Bradford was 25 years ago who needed spine surgery. Word of mouth and reputation is important, but not guaranteed. Thats why it's hard to say, go see so and so because of the guilt should something go wrong. I think that using a scoliosis center is better even though I didn't do that. My surgeon convinced me that his surgical team was excellent. The surgical team is important and this should be brought up in discussions instead of assuming.

I will question reviews....at least with me, I have bending photos and skiing videos. (Fake bending photos! Ha ha) Of course, we all know about bad cases, surgeons that do difficult problem cases are going to have higher rates of bad cases. I don't think it helps to ask about how many bad cases or if one has been paralyzed since it's not going to affect your decision if you like your surgeon. Things can happen. If you ask and the truth comes out, your going to see the compassion. There are negative reviews here on the best surgeons in the world. Doesn't mean I wouldn't use that surgeon.

I think it's important to address everything and talk about everything involved over multiple meetings so everything comes out. The surgeon also has to know if one has any non medically related factors or surprises like divorce, or taking care of 90 year old grandparents, being in a jury trial in 2 weeks, or having financial problems that require returning to work during a scoliosis surgery recovery. I remember a nurse here returning to work too soon during recovery and she was in misery.....

My surgeon told me that if anything was wrong, to come down here right away without an appointment. Just come down. You have to hear things like this and you won't unless the discussion and relationship is established and that takes a little time....There are things we have to hear, this is just one of them.

For the most important decision of your life, none of this stuff comes easy. But we have to do this for ourselves or our kids.

Ed

[Tina_R]

This was probably my very first question....where were you trained? (and didn't mention it in my post above) and of course I knew all about TCSC and SRS for a long time. I also asked where my 2nd scoliosis surgeon was trained. I know a non scoliosis patient who knew who Dr Bradford was 25 years ago who needed spine surgery. Word of mouth and reputation is important, but not guaranteed. Thats why it's hard to say, go see so and so because of the guilt should something go wrong. I think that using a scoliosis center is better even though I didn't do that. My surgeon convinced me that his surgical team was excellent. The surgical team is important and this should be brought up in discussions instead of assuming.



Ed

What percentage of all surgeons doing spinal fusion for scoliosis were trained in these elite schools? What's wrong with going with surgeons who were trained somewhere else, what do they lack?

[titaniumed]

What percentage of all surgeons doing spinal fusion for scoliosis were trained in these elite schools? What's wrong with going with surgeons who were trained somewhere else, what do they lack?

Tina, I have no idea on percentage.

Here is a 124 year history of Twin Cities Spine Center
https://www.tcspine.com/media/1170/history.pdf

Interesting scoliosis related reads will include history and progression of places like...(Use Google)
TCSC Twin Cities Scoliosis Center or Spine Center Dr Moe
HSS Hospital for Special Surgery 1863.
https://www.hss.edu/history.asp
UCSF University of California San Franscisco 1864
https://www.ucsf.edu/about/history-1
SRS Scoliosis Research Society

Read Dr Cotrels book "In the Sands of Berck" He was a famous French scoliosis surgeon who traveled the world looking for answers in scoliosis. He invented the CD system around 1981. All profits from that system go into scoliosis research today. Paid for by all the prior scoliosis patients. Dr Cotrel is a Saint.
https://www.amazon.com/Sands-Berck-U.../dp/B003Y5BQ7O

Today, there are many more scoliosis training centers...They have found out that there are too many of us! A lot has changed over the years, and technology has advanced leaps and bounds.

Scoliosis surgeons are trained to "balance" the spine, select proper levels for fusion... If you don't balance the spine your plumb will be off and you ending up being pitched forward, back, or to the side....I would imagine that with a long fusion like mine that its critical especially down low at the sacrum. Like planting a tree. Curves need to be balanced.

They also have to be trained to use many of the scoliosis hardware systems. I had a "tower of power" used, it's the device that rotates the rods for correction. If you look at surgical videos, you will see these tall stainless devices on every screw head on each side that stand up about 6 inches high. They didn't have the tooling many years ago, and surgeries were done old school. Like Dr Boachie with Juma Genda (Surgery saved my life video) attaching straight rods at the top and bottom and connecting at the center. Straightening by leaning in and pushing on the spine. They train in specialized scoliosis related procedures that a regular orthopedic won't have training in. These are just 2 tip of the iceberg things I am mentioning here.

It helps to know who has been on the scoliosis scene. Who does great work, and who trained with who....My surgeon stated that Dr Bradford was his mentor...Before UCSF he was at TCSC. It all gets handed down....

I never met Dr Bradford, but I have to give a sincere Thank You since he developed one of the ALIF procedures used on me a long time ago. It worked. He did an incredible job on Brad (Quikdraw) back in 1983 with a Luque Wire procedure. His posts are here, use search. Brad is up in Canada.

Ed

[jackieg412]

Ed is a value wealth of information. Anyone of us has had a different journey through the big decision that we have to make. It is easy to research now. Also things change as new procedures are becoming available.
There really are just a few surgeons in any given area that are known for their work in deformity surgery.
But the key is doing your research and listening carefully. Even making multiple appointments to ask questions. But also remember no one doctor can answer about everything. If the doctor listens to his patients also , they have a better idea how a recovery process goes.
As far as no visitors, you can record your visits . After surgery, at first, you will not feel much like visiting with anyway.
We also need to believe that the surgeon wants to have a successful outcome. And that takes a lot of work on the patients part.
This last surgery for me, in October, was a major very risky surgery that according to my surgeon wasn't even available until 5 years ago. Before surgery he said something that I think everyone needs to hear ---"I can make you no promise about the outcome but I promise you I will do my best for you". I thought it was honest and heartfelt.
Tina he is a well trained surgeon. He trained first in this native country( Brazil) and had to repeat everything but his MD to practice in the US. So he is multiply trained in surgery.

[LindaRacine]

Linda, what do you think is missing if the surgeon didn't go through a complex spine fellowship? What has a greater chance of going wrong without that training? Or what do fellowship-trained surgeons do better? Does that program turn out neurosurgeons as well as orthopedic surgeons?

Really useful reviews of doctors are small in number.

Fellowships in spine surgery (both orthopaedic and neurosurgery) can give new surgeons the opportunity to be involved in a large number of complex surgeries. Unfortunately, most attending spine surgeons do a relatively low number of complex surgeries. A spine surgeon in a major spine center probably does at least 20-30 complex cases a year. The really well known surgeons probably do 100-150 complex cases a year. Spine surgeons in more remote, rural communities may not do any complex surgeries. Just like anything we train to do, the more you do something, the better you get. It is not at all uncommon for problems to occur during complex spine surgery. A well trained surgeon (and their support team) will have a much better chance of recovering than someone who hasn't experienced a specific problem previously.

You're right, the number of reviews is small. Wish that wasn't true.

--Linda

[LindaRacine]

I understand but I think that most people are concerned with what they put in their bodies....that includes spinal hardware.

And your right, we are not going to know if it's a good or bad selection so you ask and let the surgeon explain why. I had a hardware switch and a surgical method changed and of course all of this was discussed. Things got complicated because I waited too long. Sort of like ignoring cancer. It might not be an emergency, but there is a right time and a wrong time to have surgery.

Having 2 different opinions is a problem. One might think that a highly invasive open procedure is too extreme, but then how do you know if a minimally invasive procedure is going to address everything? This was something on my plate. Minimally invasive procedures were probably not as developed as they are today....13 years has passed. Tough decisions that involved a lot of trust in my surgeon's expertise. To build on that trust takes some communicating.

Recovery questions I would think would be automatic....How could one not ask what one is going to go through?

I forgot sock installers, log rolling, and walkers. I knew I was forgetting things. I don't use sock installers or walkers anymore. I will admit that clipping my toenails requires that long stretch....it's not easy being fused up to T2. But, it can be done.

Ed

Sorry to be so blunt, but...

The truth is that the actual procedure and implant selection usually isn't done until a few days before surgery. If you ask a surgeon what they'll use, they'll give you an answer, but as you know, it can easily change between your appointment and your surgery. Having something like that change can cause a great deal of anxiety in some patients. Having been in the room hundreds of times when surgeons discussed surgery with patients, I've seen how a bunch of needless questions can derail an appointment. I've seen the look on surgeons' faces when patients pull out a long list of questions. If you think it makes you look smart, I think that may be a delusion. Going in with a list of someone else's questions won't be productive. I think it's a waste of time to discuss implants and procedures, when one can use that time to discuss the experience and expectations.

--Linda

[jackieg412]

As far as the type of brand of hardware, I would only think you need to know what was used after the procedure. The information was needed when I had revision surgery done by a different doctor.
I knew the type but he had me get the information from the hospital where it took place.
Since my recent surgery, and I asked after my last visit, he used the words but reminded me of will be in The hospital records.
As we know,one type doesn't fit all.