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    Spine Surgery: Getting It Right the First Time

    Considering a spine procedure? It takes more than a skilled surgeon to ensure a successful one, says Dr. Todd Albert, surgeon-in-chief and medical director at Hospital for Special Surgery (HSS), rated #1 in the U.S. for Orthopedics for each of the past six years in US News & World Report's Best Hospitals ranking. According to Dr. Albert, getting the procedure done right the first time takes an entire team—physicians, support team, hospital, and you.

    Here's how the HSS team of experts works together to optimize a patient's healing.

    The Surgeon:

    • Obtains a thorough, accurate history of your problem and confirms it matches the diagnostic imaging. In other words, do your symptoms go along with your test results? "Because your doctor depends on you to tell him the complete history of your ailments, it's important that you describe exactly where the pain is and what brings it on," Dr. Albert says. Keep a notebook of your observations and bring it with you to the appointment.
    • Collaborates with specialists to individualize your treatment plan. Your course of treatment should not be determined solely by your doctor, Dr. Albert says. At HSS, for example, physicians regularly collaborate closely with a team of specialists, including physiologists, anesthesiologists, neurologists, physical and occupational therapists—basically, anyone who will participate in your care. Together, they set a highly individualized course of treatment, recovery and rehabilitation for each patient.
    • Is specially trained in your procedure and is comfortable performing it. Specialization and experience can vary widely between even large and 'famous' providers of orthopedic care. The greater the number and complexity of specialized conditions treated by a physician, the more likely they will 'get it right the first time.' "It's important that our doctors have a wealth of experience with a variety of spine problems and are willing to provide you with names of patients who have had the same procedure and can tell you about their experience" says Dr. Albert.
    • Educates you, the patient. "You don't have to know all about the technical details of your treatment," says Dr. Frank Schwab, Chief of the Spine Service at HSS. "However, you do need to understand your role—and what's expected of you—during the entire process."

      This includes:

      • How to be confident in your choice of caregiver
      • How to prepare for surgery
      • What to expect post-surgery, including the activities you'll be able to do right after and those that are off-limits for a while
      • Recovery time and how long you should plan to take off of work
      • Modifications you'll have to make to your home while you're recovering
      • What your rehab will entail.

    The Patient:

    • Educate yourself about your surgery. Talk to other people who have had the same procedure, and read up about your condition and treatment. A little legwork at the outset will go a long way toward helping you better understand the situation and cooperate in your care. "Patients who know what they're looking for will ask good questions," Dr. Schwab explains. "I can respond to their questions at a higher level and align treatment with what they're looking for, the risks they're willing to take, and what they'll accept for their recovery period."
    • Choose the right physician. Word of mouth can help you create a short list of doctors to consider, but in the end, choose the physician who's not only board-certified but also well-experienced in performing the treatment you need. "Some good questions to ask are, 'How many of these procedures have you done?', and 'How comfortable are you doing them?'" Dr. Albert suggests. Also, look for a doctor who has a team that's capable of using multiple approaches to help patients. "That says they'll confidently use the best approach for your situation," he adds.

      Just as important is whether the physician is involved with academic societies in their specialty (such as the Scoliosis Society). "This doesn't necessarily mean they'll be a great surgeon," Dr. Albert says, "but it means they're questioning what they do. They're willing to look at the results and ways to improve it." Being academically involved—as many doctors at HSS are—also suggests that the doctor is sharing information with colleagues via academic papers and presentations and therefore, staying abreast of the latest techniques.

    • Research top specialty hospitals. Do your homework before settling on a facility. A hospital like HSS proudly shares performance information, such as re-admission rate, re-operation rate, and infection rate. This information should be publicly available to you anywhere, and it's important to take into consideration when choosing a facility. So do your homework, research hospitals beforehand, and don't compromise on quality simply because a hospital is nearby.
    • Come into the surgery as healthy as possible. Schedule a complete physical with your health care provider, and be as nutritionally sound as you can be. Skip the junk food and stay away from crash diets or huge weight losses before surgery, because poor nutrition lowers the body's ability to fight infection. And if you're a smoker, your upcoming surgery is a great reason to quit. "Nicotine actually degenerates discs and compromises the success of the surgery," Dr. Albert says.
    • Stick with your rehab plan. When it comes to healing efficiently, going to rehab is key. During the first couple of days after spinal surgery, taking a few steps might feel more like you're climbing Mt. Everest. "But," Dr. Albert points out, "you'll feel so good when you get to the summit. The more you move early, the less difficulty you'll have later on."

    The Hospital:

    • Maintains good performance rates. Widely available data such as re-admission rate, re-operation rate, and infection rate are good indicators of a hospital's performance.
    • Is well experienced in your specific surgery or treatment. Volume is often directly related to outcome and a hospital's level of experience. HSS, for example, does more spine surgeries in terms of volume and variety than any other hospital in the world. It follows, then, that they would provide the best, most up-to-date treatments and facilities available.
    • Is academically involved. "Besides volume, look for a hospital that innovates, that has an academic arm to what it does," Dr. Schwab advises. "The reason why is not that you'll be treated by researchers, and it may not affect your specific operation, but it's a culture. An academic culture is very different because it obligates you to regularly question what you're doing. It ensures that you're at the top of your game and innovating procedures."

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