Monday Medical: Predicting success of spine surgery
April 9, 2018
For people dealing with severe back and neck pain or arm and leg pain, spine surgery can be very effective.
But there's a catch. While a patient's symptoms and imaging findings may suggest surgery will improve the condition, some patients have preoperative conditions that can affect the outcome.
Now, doctors have another tool to help in the decision-making process: predictive analytics. Scores of data on patients who have undergone spine surgery are used to make connections between characteristics of patients, such as whether they smoke, use opioids or are overweight, and surgery outcomes.
"With elective spine surgery, typically 80 percent of patients do well, while 20 percent don't respond," said Dr. Clint Devin, an orthopedic spine surgeon in Steamboat Springs. "The question is why are these 20 percent not responding and are there modifications we can make so these people become responders?"
Through the use of predictive analytics, doctors can estimate the likelihood that surgery will help a patient meet goals such as getting relief from pain, returning to work and recovering at home instead of in a facility.
"You can have more individualized discussions with a patient," Devin said. "Once you understand what they expect from surgery, you can then say, 'Here's the likelihood that we will be able to deliver that to you.' It creates a sophisticated way of delivering care."
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Through predictive analytics, doctors have identified characteristics such as opioid use, diabetes and depression that may prevent surgery from relieving a patient of pain. Patients dealing with those issues are not precluded from surgery, but steps should be taken before surgery to prepare for those conditions.
For instance, patients using opioids should greatly reduce or discontinue opioid use before surgery, otherwise surgery may worsen pain instead of relieving it.
"Patients need to come significantly down or off opioids before surgery, as it resets their thermostat for pain," Devin said. "If a patient is too dependent on opioids, surgery isn't going to help. Even small things that wouldn't usually hurt are extremely painful to someone on opioids. If I operate on them, they won't get results — they'll just get exaggerated pain."
Patients with diabetes should be managing blood sugars well. Patients with depression should consider participating in cognitive behavioral therapy to prevent fear of moving after surgery and to foster a positive outlook on their recovery period.
Using predictive analytics also helps set the right expectations for surgery.
"The way I like to practice is to help people be as informed about a decision as possible," Devin said. "When expectations are understood mutually between a patient and doctor, patients are extremely satisfied."
The numbers are never a substitute for understanding a patient's whole health picture. Spine care isn't just up to a spine surgeon but involves a team that may include a physiatrist, pain management doctor, primary care doctor, physical therapists, chiropractors and others.
"You need a true comprehensive approach for operative and non-operative spine issues," Devin said. "There are often four or five people taking care of every single spine problem. It takes a team."
Together, that team can help relieve patients from what can be life-altering, excruciating pain.
"When people are in the throes of misery, if you're able to meet expectations and deliver results, the impact you can have is tremendous," Devin said.
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at email@example.com.