Nov 24 2014 by Don Lawrence

Can Misdiagnosis in Spine Ailments be Eliminated?



Becoming a “Social Clinical” Spine Surgeon

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I recently read an article in Spine-Health that highlighted 3 tips for finding the right spine surgeon. While the 3 tips definitely caught my attention, the first paragraph of the piece really struck me, as it validated what we’ve learned over decades in the healthcare industry – that most failed back surgeries are a result of inadequate preoperative planning. This involves  deciding which neural structures require decompression, intrumentation/fusion levels, the need for spinal realignment, and several other important factors. While most surgeons are technically capable, judgment regarding treatment strategy vary widely.

 

Given the clinical and radiographic complexity of many spine cases, doesn’t it seem logical that spine surgeons would want to consult with other spine surgeons to gain insights, and achieve “best practices” on their patients? We think so, but the author of the article I read didn’t agree as he went on to say, “Realize that a second opinion is not always the best opinion.” That said, after further reading, I learned that the advice to stay away from second opinions was meant for the patient and not for the surgeon.

 

So I started thinking about the manner by which spine surgeons – all surgeons of various disciplines, for that matter – could efficiently get another “expert” opinion on tough cases. Having real-time, valuable written dialogue with peers about spine cases would likely result in a more durable spinal reconstruction with the optimal bone grafting solution (in cases that necessitate fusion). You see, we’re all about second opinions; and in fact, third and fourth opinions – but amongst professional peers, not the general population. Our philosophy is that if an opinion from a colleague or two can improve a patient’s outcome by a mere 10%, isn’t that a no brainer? Doesn’t that make collaboration with colleagues a must?

 

Let’s take a patient case as an example. A 57-year-old Caucasian female visits an emergency room complaining of neck pain one month after falling and sustaining an injury to her occipital bone. She had already visited one physician where pain originating from the cervical spine was treated with analgesics and physical therapy. No radiology images were taken and no collaboration with other physicians was conducted. Persistence of pain led to a second assessment by another physician one week later at another hospital. Analgesics were once more prescribed and radiological screening was once more not considered essential. She then visited the ER for continued pain, where images (lateral, anteroposterior and odontoid views) were ordered. Several clinicians collaborated on the patient images and agreed that the C5-C6 facet dislocation – now finally radiographically diagnosed – resulted in cervical instability and placed her in great danger neurologically if left untreated.

 

Our community of “social clinicals” as we like to call them, agreed that the ability to connect with other spine surgeons around the globe, share images and collaborate via their mobile devices is invaluable. Their feedback was that yes, they are experts and are trained to be precise, thorough and scientific, but that they are human and therefore, can make mistakes – mistakes that can be alleviated by learning best practices from their peers. They shared their frustration as the various challenges that have inhibited their ability to collaborate including geographic and technological boundaries. What was even more interesting is that when asked, their patients agreed that having their spine surgeon seek other opinions and insights made them feel more comfortable with the final plan for their surgery.

 

If you are a spine surgeon, we want to hear your thoughts on social collaboration and image sharing without boundaries.