Medical Practice in the Real World Part #2

Cathy is a 35 year old who was unable to walk or even straighten her back. She had numbness and weakness in her legs. Her MRI demonstrated severe deformity due to infection at L3 and L4.

We took Cathy to surgery. We opted to approach the problem initially from the side with a minimally invasive lateral surgery. We were able to remove the affected bone and place an expandable cage for support. We then went in from the back and supplemented the cage with screws and rods. Surgery took 5 hours and we lost about 150 ml of blood.

Cathy was able to walk the day after surgery. She noted post-surgical pain She has full strength in her legs and some persistence of the numbness.

The cage we used for Cathy is made by Nuvasive and is an example of the incredible advancement in spinal technology. This cage helped lift the spine as it was deployed and it uniquely supports the bone. It was placed through a small incision utilizing a superb retractor system.

Advancement in technology is a challenge in modern practice. Each medical implant must be under contract with the hospital. I have found that my input into this process matters much less than I think it should. I think we should have well informed cost conscious physicians making decisions based on their knowledge and expertise. Instead, the decisions are made by hospital administrators with very little understanding of the devices whose primary interest is the cost of the implant, rather than its value.

The solution is a healthy relationship with the physician and the hospital administrators, working to find ways to provide excellent and good value care. The ultimate decision maker though, I think, should be the physician. Why? The physician is the one ultimately responsible for the patient’s outcome.

The patient doesn’t call their hospital administrator when they are in pain or they don’t heal after surgery. They call their doctor.

Disclaimer: Although this is a real patient, I have used a different name for privacy protection and added a few details for educational purposes. This patient gave consent to have his case shared.

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