What are the Chances the Surgery will be Successful?

“Doc, what are the chances that the surgery will be successful”?

This is one of the most commonly-asked questions by patients who are considering spine surgery. The answer depends on a number of factors, starting with how a “successful surgery” is defined.  To keep things simple, let’s assume that a “successful surgery” has:

1. A low complication rate (risk).
2. “Substantial clinical benefit,” which is a high likelihood of significant improvement in symptoms.

The ideal surgery is one with the lowest risk and highest chance of being beneficial to the patient.

Risk

Risk is measured based on the complication rates associated with a surgical procedure. Complications fall into two categories:

1. Surgical complications like infections, blood loss, blood clot, new neurologic deficit (weakness), and unplanned return to the OR.
2. Medical complications such as heart attack, stroke, pneumonia, blood clot in the leg, and pulmonary embolism.

Complication rates vary based on the type of procedure, but they should be as low as possible to reduce the risk.  Measuring complication rates is fairly straightforward, and many are tracked by the hospital, so if your surgeon cannot tell you what his or her complication rate is for a given procedure, you may be able to get that information from the hospital.

Benefit

Clinical benefit describes the amount of improvement in symptoms after undergoing a certain procedure. There are 3 commonly used tools in spine surgery to measure clinical benefit:

1. Visual Analog Scale (VAS) is a pain score on a 1-10 scale, with 0 being no pain, and 10 being the worst pain possible.  Back and leg pain are typically measured for patients that undergo lumbar spine surgeries, and neck and arm pain scores are measured for patients that undergo cervical spine surgeries.
2. Oswestry Disability Index (ODI) & Neck Disability Index (NDI) are used to help determine the amount of disability a patient experiences due to their spine condition. The ODI and NDI are both 10-question surveys that measure a patient’s ability to perform everyday tasks. They are then scored on a scale from 0 to 100, with higher scores meaning greater disability.  This is the most commonly used tool to measure disability and level of function in patients with back and neck pain.
3. SF-36:  This general health survey is perhaps the most commonly-used in medicine today because it is a good measures of quality of life, but it is not specific to spine surgery. This survey consisting of 36 questions that determine how much your daily life is affected by your medical condition). The SF-36 then gives a score from a scale from 0 to 100. Unlike VAS and ODI scores, however, a higher score means a better quality of life.

But a 50% improvement in an ODI does not correspond to a 50% improvement, and what’s statistically significant may not be clinically relevant.  In an effort to better translate these outcomes to real world use that people can understand, the concept of “minimally clinically important difference” (MCID) has been used.  This the minimal amount of improvement that a patient can even recognize, but for us as surgeons, setting this as our goal is setting the bar really low.  After all, patients don’t want to know what are the chances that they will be minimally better, they want to know what are the chances that they will be significantly, or substantially better.  Thus, many are now using the much more lofty goal of “substantial clinical benefit” (SCB).   A thorough explanation of this concept is beyond the scope of this article, but in essence it sets a new, “high watermark” for determining how much a patient will really improve with spinal surgery.

If a surgeon uses these tools, then he / she should be able to give a patient a more accurate answer to the question  “ doc, what are the chances that the surgery will be successful”?   Ask your surgeon these questions, ask if the answers are based on personal experience, personal data, or the “literature”.  Also always ask about how many cases like yours he or she has performed.  Even if you are satisfied with the answers, always get a second opinion. Most good surgeons are not at all offended if you want a second opinion, and should encourage it.

At Georgia Spine & Neurosurgery Center, we believe that the best outcomes and lowest risks are achieved through proper patient selection, and the use of minimally invasive techniques almost exclusively.