Becker's Spine Review

13 Population Health People with back pain follow a similar trajectory that can lead to many problems down the road; they experience back pain, but don't see a spe- cialist until it becomes unbearable. At that point, physical therapy and lifestyle changes may not be enough, so the patient has either interventional treatment like steroid injections or pharmacologi- cal treatment like steroids. While these methods can mask the pain long enough for patients to at- tempt rehabilitation without surgery, it may not fix the problem for everyone. With persistent back pain, patients are less ac- tive and may not be able to work. ey become depressed and sometimes addicted to their pain medications. ese patients are more difficult to operate on if surgery is necessary, and are less likely to achieve good outcomes. In many respects, the best way to treat this popu- lation is prevention. "Spine care should be focused on preventative care instead of wanting to treat the damage that has already occurred," says Dr. eofilos. "Core strengthening is essential to help protect the spine as well as lifestyle changes including liing tech- niques and proper posture. is is very similar to cardiac care. Instead of waiting for bypass surgery to treat blocked arteries, the focus should be on preventative care with diet and exercise." In addition to diet and exercise, prevention also includes balance conditioning and proper pos- ture. ere are products available, including AlignMed, that help people with bad posture maintain good posture to prevent back pain and further issues. "Proper posture is key, and the beauty of AlignMed is that it forces you to stand proper- ly," says Stephen Hochschuler, MD, co-founder of Texas Back Institute in Plano. "I also advise a proper ergonomic chair. Your spine is in bal- ance. Years ago, all we cared about was dealing with the patient's pain and doing fusions to get the spine straight. Now the hot word in spine is alignment." e focus on population health in spine surgery is a paradigm shi for most surgeons. Here are a few ways the surgeon's practice is changing as a result: 1. Surgeons are ordering their own physi- cal therapy plan. Dr. Hochschuler learned from sports medicine physicians that ordering physical therapy doesn't always mean the thera- pist knows how to optimize individual patients. He makes sure all his patients undergo aerobic conditioning, core strength and balance training. 2. Focus on education for proper posture. e traditional posture points are sitting and standing, but surgeons are now adding a few new messages into the mix: • Not looking down at phones; instead, hold- ing them eye-level • Making sure computer screens are raised to eye-level when sitting or standing • Proper biomechanics in sports, especially golf swings 3. More time is spent on education in dif- ferent media. Television ads and magazine pamphlets can spread the word about back pain prevention in the local communities. When peo- ple see surgeons becoming the face of prevention, they'll remember that surgeon if back pain does arise, or recommend that surgeon to friends and family with back pain. Lectures at health clubs are an easy way to spread the word about prevention, and surgeons can write articles for websites circu- lating beyond their community. "Spine surgeons should broaden their practice to- ward earlier patient care rather than just wait for surgical referrals," says Dr. eofilos. "Getting in- volved with community education, physical ther- apy programs, as well as other support groups, will allow people to become educated earlier on preventative spine care." One of the challenges for spine surgeons in this paradigm shi toward population health is the time it takes to provide education. Whether it's describing prevention methods to each patient at visits or writing blog posts for a weekly update, education is time-consuming and oen unbillable. "We aren't getting help to finance our education efforts," says Dr. eofilos. "e physician has to do it because he knows he's doing good work for the community. If we spend time educating pa- tients in the office or lecturing on preventative measures, we'll help patients in the long run." n How Spine Surgeons Fit Into Population Health — 3 Key Ways Practices Are Changing (continued from cover) Dr. Charles Theofilos Dr. Stephen Hochschuler 5 Predictions on the Future of Spine By Laura Dyrda A s for spine care, David B. Nash, MD, MBA, founding dean of the Jefferson School of Population Health has a few predictions for where spine practices will trend in the future: 1. e number of spinal fusion procedures will increase significantly with the aging baby boomer population. 2. Ambulatory surgery centers will be a huge opportunity in the future because surgeons can provide quality care at a lower cost, and mobilize patients more quickly. 3. Readmission rates are still higher than most facilities desire for spinal fusions, and many times patients are returning to emergency rooms at other hospitals than the one where their original surgery was per- formed. is could create problems in the future. 4. e average age of the spine surgery patient will creep into the 60s as people live longer and desire to remain active longer. 5. High-volume surgeons will be more sought aer, until spine-focused surgeons are performing the vast majority of cases. Low volume sur- geons oen have worse outcomes, longer length of stay and high com- plication rates than high volume surgeons, according to the literature. n

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