August - December 2007 Issue
Surgery Is Last Option at Multidisciplinary SpineCare Clinic
Shekar Kurpad, MD, PhD Medical College of Wisconsin Neurosurgeon
In most care settings, about 12 percent of all patients with spine problems end up having surgery. At SpineCare, the surgical rate is less than half that figure. Dr. Shekar Kurpad talks about how the multidisciplinary SpineCare approach helps people get the most conservative treatment with the maximum possible benefit.
Q. For whom was SpineCare designed?SpineCare is for people with problems of the neck or low back as well as some patients with mid-back problems. Pain is the most common reason we see patients here, and this could involve pain in the neck or low back or pain, numbness or other problems in the arms or legs. Other symptoms could be tingling or hot and cold sensations.
Q. What is the difference between acute back pain and chronic back pain?Acute and chronic are words that tend to signify how long back pain has lasted. A patient with acute back pain is a person who has never had back problems before and who suddenly experiences a serious issue with back or neck pain. Acute back pain is usually the result of a motor vehicle accident, a work-related injury, a lifting injury or any obvious trauma that is immediately followed by severe back pain.
Chronic back pain is a situation in which the whole symptom complex develops over a period of time, starting gradually and getting slowly worse. Generally, most chronic back or neck pain is the result of arthritis or degeneration. The technical terms are osteoarthritis and rheumatoid arthritis — or in lay language, simply getting older.
It is possible, and we see this all the time, that a patient who has chronic back pain will have what we call an acute exacerbation. They are living with a certain level of back pain and then they come to see us because they suddenly become worse than what their base line was.
Q. Could you describe SpineCare’s multidisciplinary approach?SpineCare has a comprehensive team of people who specialize in addressing various aspects of treating spinal conditions. We have specialists who are experts in general physiatric care, chiropractic care, occupational therapy, physical therapy, neurology, interventional pain management and spine surgery. The sole focus of each of these experts is the spine, and we have the entire spectrum of all the subspecialties that are needed to take care of spine problems.
Q. What’s the background of this approach?The Neurosurgery Department at Froedtert & the Medical College of Wisconsin was the first in the country to have a specialized spine surgery fellowship program. The interdisciplinary spinal care model is a model that evolved, and it continues to evolve. SpineCare is a forerunner of this model. It’s an approach that is now becoming more and more popular all over the country.
Q. SpineCare’s surgery rates are relatively low. Why?Surgery is and ought to be the last option for the care of any patient with a back ailment.
In the ordinary community setting, most patients with back or neck pain go to one of the different specialists I just mentioned. As a result, their care is sort of skewed towards whichever specialty they start out with.
At SpineCare, we pass all of our patients through a triage process whereby we as a team decide on the best treatment plan. We have treatment plans (flow diagrams, if you will) that help us decide what non-surgical treatments a patient has to go through prior to being qualified for surgery. We have strict guidelines as to who qualifies for surgery in the early part of their care. These guidelines are instrumental in making our surgery rates very low — less than 5 percent.
Q. How does SpineCare develop its treatment plans for surgery?Our approach is based partly on national guidelines for state-of-the-art surgical care for spinal patients and partly on surgical treatment paradigms developed here.
Our treatment paradigms cover not just the technical aspects of the surgery, but also pre-operative and post-operative care. What data must we have to get a patient into surgery? How much pain medication should a patient get and what particular type of pain medication? What follow-up visits and imaging procedures should patients receive? And it doesn’t necessarily stop at surgery. Our standards also cover non-operative management.
In other words, everything we do has been thought about, no matter how small the detail is, and all of it is based on data acquired from evidence-based medicine — both in terms of national guidelines as well as our personal combined experience.
Are we doing this correctly based on the proof that exists out there? How could we improve? Among our team, that’s a constant circle of thought.
Q. What are the program’s patient outcomes?Well, the figure I mentioned sort of speaks for itself. Our surgical rate is under 5 percent, so that means the other people got better without surgery.
Q. How do patients feel about SpineCare?I think patients generally don’t get the feeling that the moment they come here they are going to be operated upon. They get the feeling that we care about trying to get them the least risky intervention with the maximum possible benefit for them.
I always follow up with patients who receive non-surgical management, and those patients who improved are always very pleased with how things went. I would be happy too if I just avoided a big surgery.
And those patients that do end up having surgery are very glad for the non-surgical management experience, for two reasons: One is that they tried everything they could in a formal, specialized setting and now they know that the surgery is, in fact, inevitable. Plus, receiving non-surgical therapy before surgery helps them greatly in their post-operative rehabilitation.
Source: Every Day
Date: Aug - Dec 2007 Issue