A keyhole surgery in progress.
‘On-going advancements in medical knowledge, technology and equipment have made spine surgery operations much less risky today compared to two decades ago.’
A MAN had spinal injury but felt fearful of seeing a doctor to receive treatment because he and his family were afraid he would have to undergo spine surgery and be worse off afterwards –- or worst yet, become totally paralysed.
The man spent months in increasing pain, unable to work to provide for his loved ones until he could not bear the suffering anymore and finally made an appointment to see a spine surgeon.
The surgeon recommended surgery but the man was reluctant. After much persuasion and despite his fears, he finally agreed.
And to his surprise, the surgery was a success and he managed to make significant recovery.
He told the surgeon later that if he had known earlier, he would not have delayed the surgery and saved himself the needless suffering.
Consultant orthopedic spine surgeon Dr Wong Chung Chek shared this true story with members of the press recently to demonstrate the types of misleading perceptions and information about spine surgery which most of the public still foster today.
On-going advancements in medical knowledge, technology and equipment have made spine surgery operations much less risky today compared to two decades ago but public perception and awareness surrounding spine injury and treatment have not necessarily kept up with the times.
According to Dr Wong, generally, the public still feel a lot of fear and apprehension whenever they hear the words “spine surgery”.
“It’s understandable because 20 years ago, spine surgery was a big thing.”
When he was a junior doctor, some spine operations could take up to 12 hours, and also likely to lead to a number of complications.
For example, the longer an operation took, the greater the possibility something could go wrong. In addition, this type of major surgery also meant the operating medical team had to deal with possibly complicating factors such as blood loss.
Unfortunately, that kind of public perception towards spine operation has remained up till now to the detriment of patients who would benefit from or experience relief after having the surgery.
As a spine surgeon who has seen many patients’ lives improve after surgery, Wong felt it is important for the public to arm themselves with accurate information which can dispel some of these misconceptions.
Improved technology
To illustrate his point, Dr Wong said the spine surgery procedure, which used to take 12 hours, could now be completed in three hours – thanks to improved medical instrument technology.
“The instruments and equipment we use make it so easy for us to do the work. It’s not that the doctor has become better, it’s the instruments that make the task easier for us,” said Wong, who has been performing spine surgery since 2000.
“Not only is it easier to perform but also safer. We can do it faster as well.”
Implants such as pedicle screws and artificial discs, used to replace or support body parts during spine surgery, have also undergone a lot of changes and improvements over the years.
Monitoring and tracking
Dr Wong acknowledged that due to the nature of the spine which protects the spinal cord, there is always the risk of nerve damage occurring during surgery.
However, improved machines are helping surgeons to keep track of the electrical signals of the spinal cord, meaning that they can tell immediately during a surgical procedure if the spinal cord is affected.
“Ten years ago, we already had such machines but they were not accurate and gave off a lot of false alarms. And sometimes when something went wrong, they did not pick it up,” he explained.
Through advancements such as neuromonitoring, surgeons are able to keep tabs on the patient in real time with the help of machines that constantly check the patient’s sensation, movement, spinal cord and nerve status, depending on the situation.
“With these machines, not only will the patient be more confident, the doctor will also be much more comfortable,” Dr Wong said, adding: “It’s a big landmark and helps to make spine operations safer.”
Other improvements such as keyhole or minimal invasive surgery and products which reduce bleeding from surgery help to reduce patient injury and also improve patients’ recovery times.
Other technological advancements have been translated into imaging machines which help surgeons to virtually ‘see’ inside the patient’s body so they can minimise unnecessary cutting and complete difficult procedures more safely.
“When we do operations, we don’t have the opportunity to see the bone all around. The more you see, the more you have to cut and the more you damage the patient,” he said.
“In keyhole surgery on patients with complex problems, we only see a small part. So how do we know what is happening? With surgical navigation enabled by things such as CT scans, there is a way for us to match what we do with what the scan shows.”
Surgery navigation uses similar technology and concepts as that employed by the popular gaming console Nintendo Wii.
“Wherever you put your instrument will be shown on the screen. That means you actually can do a lot of procedures without seeing the whole bone,” Dr Wong added.
The machines’ accuracy is such that it can tell surgeons where their instruments are located in a patient’s body within 2mm margin for error. Some machines go as low as 1mm or less error.
Advanced imaging technology also means the surgeons can more accurately locate the problems or potential problems, and plan for it accordingly before even a single incision is made.
“Yes, of course the cost goes up because we have these new technologies,” said Dr Wong who helped to pioneer minimally invasive spine work in Malaysia.
“But still, I think if you talk of quality of human life, you cannot measure with money. Even though cost of health care is going up because of these new advancements, still our standard of living is also improving, so to me, it’s not unreasonable to have more expensive things which give you a better outcome,” he added.
l In the next instalment, Dr Wong talks about how far medical training has come.