Answers about Controversial Trends in Spine Care

@stantallusa Only a surgeon can clarify what the tools are that they use and how they use them, so we can't assume anything about an advertisement. Calling something a "cyber knife" instead of the actual product name sounds like a term to make it less worrisome and more attractive to patients. I know that isn't an answer to your question, but it is so important to ask questions so you fully understand everything about surgery you are considering. I have not sought out surgeons who are advertising for patients, and personally, I would have a hard time trusting a surgeon who needs to advertise to get patients. Some have educational online videos for patient education which would not be considered advertising. Their reputation and skills should be recognized by respected medical institutions and the ratings by the insurance companies who are funding the procedures. I look for medical literature by any surgeon I am considering and read it. I look for participation in spine surgical societies and conferences and for a surgeon who is teaching surgical procedures at the conferences. There you will find the leaders in the field. Choosing the best surgeon you can find who's interests match with what you need can make a lot of difference in the results and recovery from a procedure, and also being the best patient you can be by making wise health choices that will improve your ability to heal. Often it helps to get multiple opinions because there can be different ways to solve a problem, and the risks may be a bit different with different procedures or implants. The patient needs to make an educated choice about what is best for them with the advice of a physician that they trust.

These are great strategies for finding the best in other fields as well......and it is essential in medicine. I look with disdain at those who must advertise and create stories without substance. Thank you Jennifer.

to @stantallusa, if I may add my own advice given by a physiatrist I've worked with, look for a surgeon affiliated with a medical school to find one who has the most up-to-date skills and training. That's what I'm doing right now. I need total spine reconstruction for severe scoliosis (S-curve) and I've been searching for over a year. Covid has factored in somewhat. I was turned down by Dr. Lemke at NY Presbyterian who said he only works on "spinal deformities"--well, what is severe scoliosis but a spinal deformity by anyone's definition? That one really threw me. In fairness, he referred me to two of his subordinates; but he, himself, is not interested. Forget anyone who is advertising for patients. I agree with Jennifer that a good surgeon doesn't need to solicit business! I, too, would like to hear from patients who have been through the surgery and can tell us what it has meant to them to have their lifestyles change dramatically. I can only imagine at this point what it could mean to be unable to bend, flex and twist. It sounds bad, doesn't it? But to be rid of the pain must be wonderful. One person said she can still get up from the floor by herself, which left an indelible impression on me. I can't shake the visual in my head. Please, people, if you will, share your life after surgery with us who are scared and uneducated at this point!! Thanks.

Thanks. Good advice

@stpchair I saw from your profile that you are 73. Do you think this may be a factor in being dismissed by a surgeon as a surgical candidate? As for pain, usually surgeons can't promise to fix pain, and instead they preserve function or stop something from getting worse. I think you are right to look for specialists at centers with medical schools that are teaching about spine deformity. Are you still looking and considering surgery?

Here is a Mayo Clinic Q & A about Scoliosis https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-for-adults-affected-by-scoliosis-treatment-based-on-severity-of-symptoms/

Here are some other discussions about scoliosis that might connect you to patients with experience with treatments.

Adults living with Scoliosis, thoracic stenosis, https://connect.mayoclinic.org/discussion/searching-for-adults-living-with-scoliosis-thoracic-stenosis/

Scoliosis, introduce yourself, https://connect.mayoclinic.org/discussion/scoliosis-introduce-yourself/

Scoliosis and sleep number beds, https://connect.mayoclinic.org/discussion/scoliosis-and-sleep-number-beds/

Scoliosis and chronic back pain, https://connect.mayoclinic.org/discussion/chronic-back-pain-2c72ae/

Degenerative discs & Scoliosis, https://connect.mayoclinic.org/discussion/degenerative-discs-and-scoliosis/

Hi, Jennifer! No, I don't think it was my age. The NYP surgeon should have used a better excuse (or a better messenger) than he only operates on spinal deformities! I've talked to a couple of surgeons so far and neither hesitated because of my age. I have no osteoporosis (except for one hip) and I passed the cardio tests and pulmonary function tests just fine for an 8-hour surgery. One surgeon also said he'd just operated on a 90-year-old. So, i don't think age was the disqualifier. I think he's looking for little kids in 3rd world countries that will get him publicity. Or maybe that will get publicity for the hospital. If that's what he's about, I can't change that. Yes, I'm still looking and waiting to hear from a prominent doc at Hospital for Special Surgery in NYC. It's just that it's so far away and I have to do this ALONE! Strange you would mention an article about Sleep Number Beds. I just got off the internet from looking at the Temper-Pedic Luxe Breeze mattresses. It's a real investment at $5k+!! Sleep Number just worries me about the mechanical aspects of it. Anyway, surgery first! I really, really need to talk to post-op patients to find out what life will be like after the surgery and to find out how a person who lives alone can manage! I was in senior living for 30 years as a sales director and I do not want to have to move into assisted living for the rest of my life. I'm hoping I will be able to function independently enough to continue to live alone--even if it's in independent living in a senior living community. Not what I imagined retirement would be like, for sure. I worked 50 years! For this? Yikes. My neurologist was in favor of my waiting and not doing anything aggressive (i.e., surgery) for years because I think he felt it may never reach the point of being necessary. Now I'm not sure waiting was the best thing. I could have probably had the minimally-invasive procedure if I'd done it years ago. Woulda, coulda, shoulda. as they say. I didn't even know that alternative existed. I will check out your articles and thank you very much for caring and sharing this information.

@stpchair Thank you. I'm glad I could help. I'm glad you are a healthy 73 year old so you must have made some good choices along the way! I am in my 60's and my surgery was a cervical fusion, and even with that, I needed help. I couldn't drive and was in a neck brace 3 months because I wanted a fusion without hardware which was a good choice for me. Scoliosis surgery would be a much more extensive surgery than mine, and you will need help during recovery. I'm glad you are independent and my 91 year old mom is also "independent" but needs help from family to get groceries and meds and for rides to her medical appointments. She does have osteoporosis and just had a compression fracture in her spine and is now in rehab until the end of this week. I am hoping she will be able to return to living with minimal help at home. She has some things that help like a floor to ceiling pole with "S" curves in it that she can hold when getting in and out of bed, and a special shower chair on wheels. Do you have family that can help you? You need someone to be with you for any surgery too because you will need help. I hadn't read all the discussion about mattresses, but since it was related to scoliosis, I thought it may help. I've never tried a Sleep Number bed, but yowza....5 grand? I'm still sleeping using extra pillows for support where I need it. What was the minimally invasive procedure that you didn't do years ago? Did your scoliosis progress after that?

i appreciate the advice. I live alone and have no one who can help me. No family are close enough geographically or have the ability to take time off to help. My Mom is almost 95 and is in Independent living in a senior living community where I used to work--but, like yours, I take her to doctor appointments and help her shop, set up her pillbox, etc. She's not totally independent. This surgery will present a lot of unique challenges I haven't faced before, including not being able to help my Mom nor take her out weekly. Where did you get that S-shaped pole you mentioned? That sounds great! As long as I've been in the business, i've never seen one of those nor a shower chair with wheels. The shower chair with wheels, I'm afraid, would be seen as dangerous in the senior living industry... I suppose they lock in place, however.

The minimally invasive scoliosis procedure involves two much smaller incisions: one on the back and one on the side. The recovery period is much shorter and it's much less invasive overall, as you can imagine. I so wish I'd known about it and hadn't just left the decision up to my doctor. He really thought he was giving me the correct advice since it's a relationship of about 20 years now. i have images that go back years but I haven't asked for a comparison to see how my curves have progressed over the years. i know now mine are at 68 and 42 degrees. It's definitely in the severe category. I had to quit working because of the pain. My lowest ribs are inside my pelvic girdle and they cause me a huge amount of pain and discomfort when leaning or lifting. I can't wait for them to be lifted out of there in surgery.

I hope to hear from others who are post-op or longer to find out what life is like with rods, pins and screws, basically the length of my spine. I will have several lumbar and thoracic fusions.

I am new using Connect - was seen at Mayo 1/18/22 for review of my cervical MRI. The PA said I have spondylosis at C5-6 and C6-7 and would need surgery in the future, i.e., disk replacement with fusion. i asked about the new motion preserving spine surgery and was told only applicable if I was 30 years old or younger. I googled around and Dr. Jeffrey Cantor has a great website and YouTubes about cervical stenosis. He talks about surgery with the misonix early enough to avoid fusion. He also has a place on the website to upload MRI images for a second opinion. I uploaded my MRI this weekend and will see what they say. I also plan to contact Hopkins for a consult. You mentioned Becker's Spine - I signed up a couple of years ago and get their daily email.
I tried to contact the Mayo neurology PA by calling the dept. and leaving a message - I wanted to ask questions about the misonix and pre-emptive surgery. My call was not returned yet.

@cbove2 Hello, I am a Mayo cervical spine surgery patient. May I ask a bit about your diagnosis and how a surgeon would address it? That matters a lot in what procedure is done and from what approach.

A Misonix tool is for cutting bone very precisely and I am sure it is valuable, but there will be situations where the tool is of little value that involves something other than bone. I looked at Dr Cantor's website, and he doesn't explain what his approach is. Promoting a new technological tool doesn't tell the whole story, and you need a complete picture to understand the entire problem and various solutions for it.

Fusions are not necessarily bad, and it depends on where it is and how much movement is normal in that part of the spine. Head turning is accomplished by C1 through C4 with very little assistance from C5 or lower levels. I have a single level fusion at C5/C6 and my movement is the same and in normal range with one exception. I cannot touch my chin to my chest, it's darn close though. I have no hardware; only a donor bone spacer. The advantage is the fusion bond is stronger than any hardware to be screwed in, there will never be an immune response to foreign materials place inside, there are no screws to become dislodged or migrate, and the bone retains some of it's flexibility. I know that may sound odd because bones are rigid, but they do flex a bit because of the protein matrix in them. I am over 5 years post op and all other levels are fine. Sometimes adjacent segment disease is going to happen anyway, and even to people who have not already had a fusion. Adjacent segment disease also happens with artificial discs, but possibly at a lesser rate. That is something to ask a surgeon about.

Motion preserving hardware can fail. The spine can try to stabilize it by growing bone around it. There can be allergic reactions to metals that are now part of the spine.

The decision you make needs to be based on all the opinions and information you get, and not just the opinion of one surgeon who loves a specific tool. As much as a new paint brush doesn't make someone a good artist, a high tech tool doesn't make someone a good surgeon. They bought a tool and are using that to market themselves. The tool can make surgeries better if it is in the right hands.

You need to learn the benefits and risks of each procedure and when is the time right to do it. In general, I think active young people tend to want artificial discs so they can get back to activities with shorter recovery times. Fusion healing and bone growth takes time. For me, it was 3 months until the fusion process began to set. Think about how an aging spine will affect the procedure that you choose, and will you have good bone quality as you age? For me, the choice to avoid foreign materials in my body was huge... and I was right about that because when I broke my ankle and lived with some internal titanium plates, it caused pain, inflammation, and I had chronic hives for months that no one could explain. I had them removed after I had healed for a year, and I have not had hives since then. I used to have pierced ears and had to give that up because I reacted to every type of metal that was used, so none of this really surprised me.

It is good to get a lot of respected opinions before you choose. I also watched as many presentations at surgical conferences that I could find online as they discussed different cases, how to solve problems and what to watch out for. Sometimes, the risks are not spelled out so clearly to patients, but when surgeons talk to each other, they are pretty honest about the pitfalls because they are there to teach. One thing to look at is how respected a surgeon is in his (her) own field. Are they presenting and teaching at the spine society conferences every year? Are the institutions they are affiliated with respected? Keep in mind, some surgeons are in this for profit and they may own their surgery centers. Take that into consideration when you are trying to decide if you are getting an objective or a biased opinion.

Can you explain what it means to use a Misonex tool early enough to avoid a fusion in the future? I don't know what that means. Has the surgeon fully explained why he thinks this tool has improved benefits and in what situations it is beneficial?