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Ask Dr. Santos: What Is The “Gold Standard” In Spine Surgery?

Surgical procedures for disc degeneration are always evolving and advancing. Dr. Santos explains how a procedure comes to be considered the “gold standard” in spine surgery.

Spinal fusion is currently considered the “gold standard” among surgical procedures used to address advanced degenerative disc disease. Over the last few years, alternative options to fusion have become available. One example is disc replacement surgery, which involves replacing the diseased disc with an artificial disc, thereby avoiding a fusion. Spine surgeon Dr. Edward Santos explains how surgical procedures are evaluated and come to be considered “gold standard.”

“Before we can offer any surgical procedure,” explains Dr. Santos, “it must be studied in clinical trials, demonstrated effective, and use devices approved by the FDA.”

What is a gold standard?

In order for a surgical procedure to be not only approved, but also considered “gold standard,” scientific evidence gathered over time must show that it’s the most successful surgery delivering the best outcomes compared to surgical alternatives. Medicine continually evolves and new techniques are approved, so “gold standard” surgery may change as researchers gather data and evaluate outcomes of newer techniques. However, it can take at least 10 years to evaluate the long-term success of a new procedure and to identify any unforeseen risks. A new procedure replaces a former “gold standard” procedure only if and when there is enough data to demonstrate that the new procedure delivers better outcomes.

Current gold standard in spine surgery

“Today, the gold standard in spine surgery for degenerative disc conditions is still fusion,” says Dr. Santos. “When a disc degenerates, a fusion procedure removes the damaged disc and ‘fuses’ together the vertebrae immediately above and below the removed disc. This fusion locks the vertebrae together and provides pain relief, but the patient loses natural range of motion in the fused segment of the spine, which then places additional pressure above and below the fused segment.

Future gold standard in spine surgery?

“Artificial discs were developed to provide a new surgical option that preserves range of motion in the spine,” he continues. “Artificial disc replacement surgeries replace the damaged disc with an implantable device that is designed to be flexible. This development is important because it helps to retain motion in the damaged spine segment. Therefore, patients don’t lose flexibility after surgery.

“More importantly,” Dr. Santos emphasizes, “when you preserve motion with an artificial disc, there is less postoperative stress on the discs directly above and below the replaced disc. A fusion procedure locks the segment in. Outcome research has shown that fusions lead to increased stress above and below the fused segment. That stress can lead to abnormal stresses in the discs, which can then degenerate, leading to further surgery down the line.”

As artificial disc surgical outcomes have been followed, some studies show that the motion-preserving benefits of disc replacement lead to better outcomes compared to fusions. Further long-term studies may lead to disc replacement becoming the gold standard for treatment in cervical disc degeneration. “There is no one surgery that is right for all spine conditions or patients,” says Dr. Santos. “Our job is to discuss the options, risks, and benefits based on the patient’s unique condition, and identify the surgery that will be his or her best option.”

Spine fusion treatment

Summit Orthopedics is home to the area’s top spine specialists for spine fusion surgery. If you are experiencing symptoms of damaged discs, the spine team at Summit Orthopedics will work with you to confirm a diagnosis and develop first an appropriate conservative treatment plan to address your problems. If nonsurgical treatments fail, or have failed, to support your lifestyle goals, fellowship-trained spine surgeons are here to consult with you and discuss appropriate surgical options, such as spine fusion surgery.

Summit Orthopedics offers comprehensive spine expertise

Our back specialists diagnose spine problems and design custom treatment plans built on a conservative, nonsurgical approach. Most patients find relief through treatments including guided injections, specialized physical therapy, biofeedback, exercise, activity modification, and medication. When conservative care does not relieve symptoms, our highly skilled surgeons offer proven, evidence-based surgical options. Together with you, we will determine the right course of action.

Start your journey to a healthy spine. Find your spine expert, request an appointment online, or call us at (651) 968–5201 to schedule a spine consultation.

Summit has convenient locations across the Minneapolis-St. Paul metro area, serving Minnesota and western Wisconsin. We have state-of-the-art centers for comprehensive orthopedic care in Eagan, MNPlymouth, MN, Vadnais Heights, MN, and Woodbury, MN, as well as additional community clinics throughout the metro and southern Minnesota.

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