How to find a doctor trained in artificial disc replacement?

According to Dartmouth Medical Atlas which does extensive research on spine surgery, there is tremendous variation in the rate of spine surgery in the U.S. with some regions having 3 spine surgeries per 1,000 population, while other regions have 8 spine surgeries per 1,000 population. Secondly, there are regional variations in the type of spine surgery performed, with some regions more advanced than others related to minimally invasive spine surgery techniques.

While some surgeons now in their 50s or 60s may have trained in the 1970s or 1980s, the spine surgeons coming out of training programs in the last 10 years typically have been trained to operate through 1-inch incisions rather than the traditional 3 inch long incisions.

This new minimally invasive surgery (MIS) approach requires the trained spine surgeon to operate through a tubular retractor resembling a large ball point pen. The instrument enables the spine surgeon to access the spine through a tiny hole and view the spine through a camera and video screen rather than a 3-inch wide incision.

While it’s much easier for the surgeon to operate through an open incision, these surgeons trained in MIS surgery for the benefit to the patient:

• Smaller incision = less time in the hospital, with many MIS patients going home the same day
• Smaller incision = less blood loss or the need for outside blood.
• Smaller incision = less disruption to muscles and ligaments, which means a faster and much less painful recovery period.

There are older spine surgeons in their 50s or 60s who have stayed current with the latest technology by going off to training programs to learn how to use tubular retractors and artificial discs. Similarly, there can be younger generalist surgeons who come out of training as a general orthopedic surgeon or neurosurgeon, and did not have fellowship training or advanced training with tubular retractors and artificial disc.

In reality, one cannot generalize about how to find a spine surgeon who is proficient in the most current procedures and technology. So age, or time in medical practice, is not necessarily a good indicator of proficiency or ability with the most current technology.

The best approach for a patient is to research the surgeon’s capabilities and the volume of cases they do that are MIS or artificial disc. A spine surgeon may do a total of about 200 spine surgeries a year, of which 20% to 50% might be done in an outpatient ambulatory surgery center where the patient goes home the same day. But this can also depend on the complex patient base that is being referred to them. The more complex the cases, the less they are able to use outpatient surgery. For example, the most popular spine surgeons often are referred the most complex cases from a 200 mile radius.

If a surgeon is not proficient with tubular retractors or artificial disc, it’s likely they will not recommend such techniques or procedures. So you will get a perspective that is biased to that surgeon’s capabilities.

Conversely if you go to a surgeon who does a high volume of artificial disc, and they advise against that for your specific case, you can likely be assured that you don’t qualify for an artificial disc.

The surgeons featured in the Centers for Artificial Disc site are all board-certified orthopedic surgeons or neurological surgeons, with many having advanced fellowship training in spine surgery.

Fellowship training involves an additional year of specialization working in a spine center and performing complex spine surgery, typically with the most advanced instrumentation.

The spine surgeons featured the Centers for Artificial Disc site are proficient in artificial disc surgery. Some limit their practice to only artificial disc surgery in the neck, while others do both neck and low back artificial disc replacement.

This Centers for Artificial Disc site has direct links to each spine center’s web site which provides additional detailed information about their physician background and treatment philosophy.

Lastly, the Centers for Artificial Disc features spine surgeons who all philosophically emphasize non-surgical treatment options in advance of spine surgery. This can include spine therapy and spinal injections. All participating surgeons believe that the best healthcare comes from an educated patient, and they encourage patients to ask questions during their visit. They all provide heavy patient education related to understanding symptoms, what causes them, nonsurgical options, and when symptoms represent an emergency.

A good spine surgeon will be cautious but open-minded about new technology. If the surgeon you are meeting with discourages questions, or outright dismisses or criticizes new technology that has been FDA approved, those are warning signs to explore a second opinion from someone with experience with the latest options in spine surgery.