Answers about Controversial Trends in Spine Care

Thank you, Jennifer, for your diligence on copyright.

@cbove2, I appreciate your posting the article that you found. I have inserted the link to the article, which you had cited by title and author as per the community guidelines on Mayo Clinic Connect. Thank you. Now the post also complies with the wishes or the source author.

CBowe, I love that you remain the optimist, pragmatist, who is data-driven and that you continue to research what might work for you. As Jennifer says, there isn't one procedure that works for everyone. What treatments seems to be the most promising for you?

Thank you so much for correcting my post to include source info - I will remember to do this in the future. As for me, spinal surgical procedures all have a degree of risk based on each individual. I will continue to manage both my lumbar and cervical disk issues with PT as long as possible if there is no progression in symptoms. At 75 years I have already experienced longer recoveries than 30 years ago and want to optimize my timing. In addition, there are ongoing improvements in surgical instruments and device materials/biomaterials. The next generation will probably get stem cell repairs and avoid much of this 😉

@cbove2 Celeste, Thank you for your recent message to me, and I would like to respond here so that others may benefit from the conversation. I am not a medical professional, but I am a spine surgery patient, and my mom has had some spine issues.

You had asked about new advances in spine care and how a patient would know if a surgeon is using the latest advances?

The answer is simply to ask when you are at spine surgery consult as a patient. I too am interested in the advances in spine care, but often the advances are trying to solve a specific problem, and it doesn't apply to all patients. If a new device is out on the market looking for how many patients it can attract, that raises a bit of a red flag. Good spine care and surgery is about doing what is the best for the patient while taking into consideration risks vs benefits in relation to their other health issues and age that could affect the success of the procedure. Surgeons don't want to make a patient worse. Sometimes problems become apparent later down the road after a new device has been in use in patients for several years.

Surgeons also have specific devices and hardware that they have been trained on and prefer to use in practice. They can't just jump into using a new implant without having been trained in its proper use or evaluating if they think it is right for their practice. They may already have another way to solve a similar problem. There are cost considerations too, and sometimes insurance companies make decisions about what they will or will not cover. Insurance companies have an extensive review of a proposed surgery and can hold out until the last day on giving approval. Sometimes at the last minute, insurance will not approve a surgery, and the procedure is cancelled.. There are different device manufacturers attending spine conferences for surgeons teaching about their products and surgeons will be making presentations about their cases and results. They can get into the details about the pros and cons of a device they have experience with, basically taking "shop" with other surgeons.

Always respect a surgeon's opinion. If a patient comes in asking for some new procedure they heard about and wants this because it is new, they are telling the surgeon how to do his job, and that likely will NOT be well received. If the surgeon has information available on his website about his procedures with a specific device, then it would be acceptable to discuss this if the surgeon is willing to consider it. They have a lot of years of education with med school and specialty training after that and you have to respect it. The patient can't tell the surgeon how to operate. Patients can and should get opinions from different surgeons and choose what they think is the best fit. A surgeon is not obligated to operate. They can back out for a number of reasons, and if they don't have confidence in the success of a procedure, they will decline. They don't want to fail. Be the best respectful patient that you can be. Sometimes the older tried and true methods are a better choice.

These are the links you shared.

Rhode Island man invents 1st biologic spine fracture implant
https://www.beckersspine.com/biologics/item/53722-rhode-island-man-invents-1st-biologic-spine-fracture-implant.html?origin=SpineE&utm_source=SpineE&utm_medium=email&utm_content=newsletter&oly_enc_id=8964C3039334A2C
This situation is specific to a person with a spinal fracture and common practice is to use bone cement to glue pieces of the vertebrae back together. My mom was considered for this bone cement procedure because of a compression fracture in her spine. This story represents an alternative for an elderly person with an implant made from human bone that can be used instead.

Smallest posterior spinal fixation implant gets FDA approval
https://www.beckersspine.com/spinal-tech/item/53753-smallest-posterior-spinal-fixation-implant-gets-fda-approval.html?origin=SpineE&utm_source=SpineE&utm_medium=email&utm_content=newsletter&oly_enc_id=8964C3039334A2C
This does sound interesting, and there isn't enough information in this news blurb to know what situations this would be used for. Hardware and spinal fixation plates do take up space and I didn't want them when I went through a cervical spinal fusion. I avoided hardware all together by just having a bone spacer and I elected to stay in a hard collar until it began to fuse which was at 3 months. It was set enough at that time to remove the hard collar and do rehab. This will be something that will be talked about at spine conferences.

Dr. Sebastian Koga debuts bone density-matched spine implant
https://www.beckersspine.com/spinal-tech/item/53764-dr-sebastian-koga-debuts-bone-density-matched-spine-implant.html?utm_campaign=spine&utm_source=website&utm_content=latestarticles
This refers to matching bone density for an older patient who has lost bone mass. For example, my mom who has osteoporosis. Her osteoporosis is severe, and it caused a spinal compression fracture. That disqualified her from a procedure with bone cement to glue the pieces back together. I presume that the bone pieces were more fragile than the bone cement itself, and the best thing was to let the spine repair itself, and begin new treatments for her osteoporosis. There are a lot of grades of bone thinning. She would not have had enough bone quality to place screws into the spine either for standard spine surgery procedures. Bone quality is very important to consider for any spine procedure.

So as you can see, there is no one size fits all new and improved spine procedure device, and that decision as to what is best is to be made by the specialists in the field. We can talk about it here, but we don't get to vote. If you are considering a spine procedure, don't allow the new bells and whistles to distract you from making a good choice in your care with a trusted surgeon. You are making a decision that likely you cannot reverse. That is key to find a surgeon who you can trust with your life, because when you get on an operating table, you are doing just that.

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.

@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?