Hinton was diagnosed by Jayashree Srinivasan, M.D., a neurosurgeon at Swedish Medical Center’s Spine Institute, as having a genetic spinal disorder in which the spinal cord is too large for the spinal column. He also had arthritis, and “There were bone spurs jabbing my spinal cord,” Hinton says. “She didn’t tell me what I wanted to hear; she gave me the cold, hard facts. I like it straight and to the point — good or bad.”
Hinton needed surgery — as soon as possible. But the outcome would be unpredictable. “Dr. Srinivasan told me that, in my case, a successful surgery is one in which the symptoms don’t get worse. They may not go away or even get better, but the important thing is, they don’t get worse. Well, my symptoms haven’t gone away completely, but they haven’t gotten worse,” Hinton says.
“I had a cervical fusion of the 4, 5 and 6 vertebra through a small incision (which is no longer visible) in the front of the neck [through the throat], bone compressing the spinal cord was removed, a titanium cage was installed around the spinal cord for stability, and bone marrow was removed from my hip and placed in my neck [to speed healing].” Hinton was released the next day. “Recovery was rough,” he says, “but Dr. Srinivasan explained everything and told me exactly what would happen.”
Hinton’s surgery illustrates the dramatic technological advances made in spine surgery over the last 10 years. “Compared to the techniques used then, it’s like we are not even talking about the same subject,” says Rajiv Sethi, M.D., chief of neurosurgery at Group Health Cooperative, health services researcher and clinical assistant professor at the University of Washington. “We are light-years ahead of where we were then,” he says. Sethi is internationally recognized for his expertise in spine surgery and was recently a keynote speaker at the annual conference of the Spine Society of Australia and Scoliosis Research Society worldwide course in Brisbane in April. A research paper by his team was just accepted for publication by the prestigious journal Spine Deformity.
According to Sethi, technical advances have transformed the field of back and neck surgery, especially the use of minimally invasive surgical techniques. Smaller incisions in minimally invasive surgery means less blood loss, less damage to the surrounding tissues and quicker recovery times. Planning tools such as computer modeling and advanced imaging with CT scans enable surgeons to measure angles and plan an operation in detail prior to surgery.
And extensive research now provides reliable indicators for the selection of the right patients for surgery, increasing positive outcomes.
Sethi is particularly passionate about choosing the right patients and planning in advance. He and his team have published groundbreaking research on the topic from data collected by Group Health Research Institute and others, based on their work at Group Health and at Virginia Mason Medical Center, where Sethi’s team performs the surgeries. “We use a multidisciplinary team consisting of neurologists, orthopedic surgeons, anesthesiologists, internists, physiatrists, psychiatrists, nurses, and others. Two or three months before surgery, we bring together all the disciplines to review the patient’s complex spinal condition and potential issues to determine if surgery is the right option. Surgery doesn’t occur without this review — or if issues that were identified are not resolved. Sometimes we need to review a case as many as two or three times over a six- to nine-month period before a final decision is made. Two attending physicians do the operation: An orthopedic surgeon corrects deformities, and a neurological surgeon corrects issues caused by spinal compression. This means a safer surgery done in a shorter amount of time.”
The team’s results are stunning: Complications after surgery have been reduced threefold, by more than 60 percent. Sethi’s Seattle spine team has shared its findings and approach in numerous papers and at conferences, and has published a detailed how-to manuscript for other organizations, including a map of the operating room. Organizations from San Diego and San Francisco to Seoul and Munich have adopted portions of the Seattle spine team’s approach.