Saturday, December 3, 2011

A Multi-part Surgical Question

Dear Doctor,

For about 6 months I have had shooting pain down my left leg - it happens about 5 times a day but it REALLY hurts.  An xray or mri or something like that showed one of my lower vertabaes is somewhat shifted, the word the surgeon used was something like "sponge hello less he says". Any way we tried a spinal injection to block the pain and i wore a Boston brace for a while. Now the doctor is recommending surgery to fuse my spine.  I hate the idea of surgery, it seems so life threatening. So I have a question.

Is there any way to find out the historical risks of surgery - including the risks from  a specific doctor?  I mean can I find actual statistics about  1) Surgery in general, 2) different types of surgeries (these must be in some database somewhere right)? AND 3) Statistics about a specific hosptial or doctors track record (at least how many people have died during his surgieries)?  Are these records even kept, and if they are are they kept secret by hospitals?

Oh 1 more question, if that is ok.  If I DONT get surgery, and decide that the pain is better than the risk, am I doing damage - so that the pain will just get worse and worse?

Thank so much for the blog



Okay, Gary,

I will be answering this in parts as I am torn between the yard that needs to be cleaned up, the NCAA football on tv all day, and my desire to help you.

First, "sponge hello less he says".... This can only be something called SPONDYLOLISTHESIS.... if you click on the link you can read all about it from the NIH,  but it is as you describe, a slipping forward on one vertebra on the one below. It is usually a result of trauma but can also be something you were born with. Either way, instability in the supporting elements of the spine allow for the slippage, and if the slip becomes big enough many more problems occur.

I am not surprised that the shots did not help. They are a temporizing measure at best, in other words, they can buy you some time in advance of surgery with some amount of pain relief, but they are not curative.

And for the moment I am going to end with this to return to your more complicated questions in a bit.... Not to make light of your situation but the surgery for this is routinely performed, and, in fact, you happen to be talking with someone who has actually HAD the surgery, usually a fusion procedure. And, perhaps if you could email me your specific concerns about the surgery being life-threatening then I could address them, but with the state of the science of anesthesia and the techniques now employed by spine surgeons I would not look at this surgery as any more risky than an appendix surgery.

I have much more to ad but hopefully this is a good start for you. Back in a bit.


Good morning Gary. I thought the above image would be instructive. As you can see, the defect that allows for the slippage of the vertebrae is in the posterior portion of the spine.

Spine surgeon have a grading system for this defect but it is less important than the symptoms and pain you are having. That alone does indicate that the surgery is probably the way to go, and, as you can see from the reference above, fusion surgery provides great results and relief of pain in 95% of patients. I am in that 95%.

As to your question regarding the historical risks of surgery, again, I would ask for some clarification. If we are going to include surgery performed back in the early part of the 20th century to our database then we will get a decidedly different result than if we use, say, the last ten years. This being said, I'm not sure if these statistics are available, though I will certainly check.

And I have now checked! The thought struck me to search for 'intraoperative mortality in the United States'. The bottom line is this... by far and away the most common cause of death in the operating room is cardiac arrrest.... heart attack, and so while I could not find statistics for TOTAL intraoperative mortality, I did find it for cardiac arrest, and you can view it here. The number is about 4 in Ten-thousand surgeries. I hope that is reassuring to you, and if you are healthy going into the surgery your risks are much lower than this.

As to your question regarding specific surgeons there IS a way to find out what patients think about their doctors and surgeons, I just don't know how accurate and valuable the information is. There are websites like Health where you can search for particular doctors or surgeons, or search for a particular TYPE of physician or surgeon in your area.

And for the moment, the one thing I DO know you can do regarding malpractice claims, inquiries to the Medical Board in the state where you physician practices will not get you information about specific problems with specific surgeries, but WILL get you information on your surgeon's track record regarding malpractice.

Gary, I am going to try to finish this up a little later, hopefully this has been helpful so far.


No comments: