Spine Surgery
Dr. Hon Vien discusses the types of neck and back pain he sees in patients on a regular basis, how to know when you may need spinal surgery, and what a first line of defense looks like to prevent spinal surgery from being a necessary course of action.
Transcription:
Melanie: Welcome to Right Beside You, a Reid Health podcast. I'm Melanie Cole, and I invite you to listen as we discuss spinal surgery. Joining me is Dr. Hon Vien. He's an orthopedic spinal surgeon with Reid Health. Dr. Vien, it's a pleasure to have you join us today. Please first tell us a little bit about yourself, how'd you get into this specialty and what makes what you do unique.
Dr. Hon Vien: Hi. Thank you for having me. I am an orthopedic spine surgeon here at Reid and I originally was a physical therapist and I had been practicing for about four years as a physical therapist. And I sustained an injury at work and I ended up needing spinal surgery. I had what they call a microdiscectomy where they go in and remove a section of the disc that was putting a lot of pressure on my leg. And I felt immediate relief after surgery. So I wanted to do something different other than therapy to help somebody with a similar problem that I had.
Melanie: What an interesting story and how cool that then you got into that field. So tell us about back pain, prevalence, impact, some of the most common causes. I mean, this is something that really has an economic impact and a societal impact. It's huge, back pain. So tell us a little bit about what you see daily.
Dr. Hon Vien: Yeah. On a daily basis, we see patients that come in for neck pain and back pain. But believe it or not, the majority of the patients that we see do not need spinal surgery. And that's one of the misconceptions that people have. They think that once you come and see a spine surgeon, that surgery is going to be warranted.
And a lot of back pain actually is what we call mechanical back pain. Mechanical back pain is back pain that you cannot see in images. And a lot of it is related to either poor posture, poor lifting techniques, tight hamstrings, tight musculature, weak abdominals. These are all things that can cause back pain that do not necessarily require any type of surgery.
Melanie: Well, that's certainly true. And as an exercise physiologist, I've been seeing that myself for about 30 years. So tell us what you consider the first line of defense. When someone comes to you with back pain, as you mentioned, not everyone is a surgical candidate and certainly shouldn't be, so tell us about some things before we get into some of the exciting advances in spinal surgery. Tell us some of the things you would try with a patient before that surgical discussion takes place.
Dr. Hon Vien: Sure. So when a patient comes in, the most important thing is the comprehensive exam. We examine you to ensure that you don't have any red flags, is what we call it, like no excessive weakness, no changes in bowel and bladder habits. And once we decide that we don't have anything concerning, then we will get some images and we would discuss with the patient what are the possible causes of a patient's back pain.
And based on that, we make certain recommendations such as physical therapy. We may educate the patient on proper lifting techniques, certain things to avoid that flare up their symptoms. And once we get that evaluation, we make the recommendations on how to prevent and even treat their current back pain.
Melanie: So then let's talk about what is next. So first of all, someone is looking for a spine surgeon. This is a big search. What are they looking for? And then after you've told us what you think are some of the most important questions patients should ask a spinal surgeon before committing to something like this, then tell us what's really exciting in your field, what's changed in the last 20 years or so.
Dr. Hon Vien: So when a patient looks and shops for a spine surgeon, I think the most important thing that they should look for is having a good relationship and a good connection with that surgeon. You certainly want a surgeon that listens to you, that does a comprehensive exam and not necessarily recommend surgery right away.
For example, when somebody comes in, we want that exam and we want to make recommendations other than spine surgery. And for a patient when they hear that, I think it's very reassuring to them and especially when they know that less than 10% of patients that come in actually do need spine surgery.
And in the last 15 to 20 years, there have been big advancements made in spine surgery in terms of the approach that we take in order to access the spinal column for the surgery and also with a new technology such as robotic spine surgery.
Melanie: well, then let's get into that, because that's pretty exciting stuff. So there's minimally invasive and you can explain to the listeners what that even really means when it comes to spinal surgery. And then tell us about how robotics is being used in this manner.
Dr. Hon Vien: So minimally invasive spine surgery, or some people call it MIS, is actually a surgical technique. And it's a way to approach the spinal column for the surgery. And as opposed to the traditional open spine surgery where the surgeon will make a long incision straight down in the center of the spine and they will expose and dissect and might even remove some of the tissue in order to get to where they need to be.
With minimally invasive spine surgery or MISS, it is actually a technique where we use such as a tube to drop a tube down to exactly where we need to be. And that way with a tube, instead of removing muscle, what it does is it moves the muscles off to the side so we can do the surgery.
Melanie: That's so cool. So tell us about the benefit for patients to minimally invasive surgery when it comes to recovery and post-surgical rehab.
Dr. Hon Vien: Sure. So with minimally invasive spine surgery, as you know, there's going to be less trauma to the muscles as well as the soft tissue compared to open surgery. So some of these benefits include less blood loss from the surgeries, because we don't have to dissect as much muscle. There's less muscle damage because there's less cutting, which translates to faster recovery. And because of the smaller incision, there is less risk of infection as well as postoperative pain. All of this translates to a faster recovery as well as less rehab that is required for the patients. And patients, because of them having less pain, means less narcotics after surgery.
Melanie: That's a great point that you make, Dr. Vien. And so tell us a little bit about your hospital's history with spine surgery and minimally invasive and robotics. And you can also tell us a little bit about the learning curve, because as you were saying about how to find a spine surgeon, certainly with robotics and these newer techniques, there's a learning curve involved. Tell us your history and how have been your outcomes.
Dr. Hon Vien: Yes. So I came to Reid Health in 2015, and that is when I introduced minimally invasive spine surgery, as well as Mazor robotic spine surgery to Reid Health. And since then, I have done more than 500 cases with the Mazor robotic surgery using a minimally invasive technique. And patients have done very well. We've had several patients that have referred family members and friends to us for this technique. We've had patients travel from several states away in order to have this surgery.
Melanie: So then when can a patient get back to activities like driving a car? What's rehab like for patients that have had these minimally invasive procedures?
Dr. Hon Vien: Rehab in general, it's much faster compared to traditional open spine surgery. In terms of driving a car, we usually tell them to wait at least five days, just because of general anesthesia being in their system. Depending on the technique or the type of surgery also, we have restrictions for them and they can range from two weeks up to three months, especially if they have a spinal fusion with the restrictions.
Melanie: So interesting. What an exciting topic. So Dr. Vien, what do you see coming in the future of spine surgery? And as you wrap up for us, give your best advice for keeping a healthy back. You're a physical therapist, tell people how you want them to keep a healthy back so they don't need spinal surgery.
Dr. Hon Vien: In the next hopefully five to ten years, there's going to be even more advancements with robotic surgeries. Every year, there's more advancement where we can get to more of a precise location into the spine. We are using cameras to look into the spinal column. We are using even smaller incisions, smaller screws. So in the next 5, 10, 15 years, we're going to see a big leap in advancements in spine surgery.
In terms of advice for a patient, I always tell a patient, always maintain a healthy lifestyle. Always watch how you lift. Use your knees to bend and lift things instead of your back. Keep your weight down. Maintain a good core strength. Keep your flexibility in your hamstrings as well as your low back. Engage in activities every day, things that you love to do and keep your back healthy and fit. That way, you can avoid the in a spine surgeon. And if you have to find a spine surgeon, my recommendation is to look for someone that is minimally-invasive-trained and somebody that has experience with the robotic spine surgery.
Melanie: What excellent advice from an orthopedic surgeon and physical therapist, Dr. Vien. Really such an informative episode. Thank you so much for joining us today. And you can call (765) 962-4444 to schedule your appointment today, or for more information, you can always visit ReidHealth.org to get connected with one of our providers.
That concludes this episode of Right Beside You, a Reid Health podcast. For more updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole.
Melanie: Welcome to Right Beside You, a Reid Health podcast. I'm Melanie Cole, and I invite you to listen as we discuss spinal surgery. Joining me is Dr. Hon Vien. He's an orthopedic spinal surgeon with Reid Health. Dr. Vien, it's a pleasure to have you join us today. Please first tell us a little bit about yourself, how'd you get into this specialty and what makes what you do unique.
Dr. Hon Vien: Hi. Thank you for having me. I am an orthopedic spine surgeon here at Reid and I originally was a physical therapist and I had been practicing for about four years as a physical therapist. And I sustained an injury at work and I ended up needing spinal surgery. I had what they call a microdiscectomy where they go in and remove a section of the disc that was putting a lot of pressure on my leg. And I felt immediate relief after surgery. So I wanted to do something different other than therapy to help somebody with a similar problem that I had.
Melanie: What an interesting story and how cool that then you got into that field. So tell us about back pain, prevalence, impact, some of the most common causes. I mean, this is something that really has an economic impact and a societal impact. It's huge, back pain. So tell us a little bit about what you see daily.
Dr. Hon Vien: Yeah. On a daily basis, we see patients that come in for neck pain and back pain. But believe it or not, the majority of the patients that we see do not need spinal surgery. And that's one of the misconceptions that people have. They think that once you come and see a spine surgeon, that surgery is going to be warranted.
And a lot of back pain actually is what we call mechanical back pain. Mechanical back pain is back pain that you cannot see in images. And a lot of it is related to either poor posture, poor lifting techniques, tight hamstrings, tight musculature, weak abdominals. These are all things that can cause back pain that do not necessarily require any type of surgery.
Melanie: Well, that's certainly true. And as an exercise physiologist, I've been seeing that myself for about 30 years. So tell us what you consider the first line of defense. When someone comes to you with back pain, as you mentioned, not everyone is a surgical candidate and certainly shouldn't be, so tell us about some things before we get into some of the exciting advances in spinal surgery. Tell us some of the things you would try with a patient before that surgical discussion takes place.
Dr. Hon Vien: Sure. So when a patient comes in, the most important thing is the comprehensive exam. We examine you to ensure that you don't have any red flags, is what we call it, like no excessive weakness, no changes in bowel and bladder habits. And once we decide that we don't have anything concerning, then we will get some images and we would discuss with the patient what are the possible causes of a patient's back pain.
And based on that, we make certain recommendations such as physical therapy. We may educate the patient on proper lifting techniques, certain things to avoid that flare up their symptoms. And once we get that evaluation, we make the recommendations on how to prevent and even treat their current back pain.
Melanie: So then let's talk about what is next. So first of all, someone is looking for a spine surgeon. This is a big search. What are they looking for? And then after you've told us what you think are some of the most important questions patients should ask a spinal surgeon before committing to something like this, then tell us what's really exciting in your field, what's changed in the last 20 years or so.
Dr. Hon Vien: So when a patient looks and shops for a spine surgeon, I think the most important thing that they should look for is having a good relationship and a good connection with that surgeon. You certainly want a surgeon that listens to you, that does a comprehensive exam and not necessarily recommend surgery right away.
For example, when somebody comes in, we want that exam and we want to make recommendations other than spine surgery. And for a patient when they hear that, I think it's very reassuring to them and especially when they know that less than 10% of patients that come in actually do need spine surgery.
And in the last 15 to 20 years, there have been big advancements made in spine surgery in terms of the approach that we take in order to access the spinal column for the surgery and also with a new technology such as robotic spine surgery.
Melanie: well, then let's get into that, because that's pretty exciting stuff. So there's minimally invasive and you can explain to the listeners what that even really means when it comes to spinal surgery. And then tell us about how robotics is being used in this manner.
Dr. Hon Vien: So minimally invasive spine surgery, or some people call it MIS, is actually a surgical technique. And it's a way to approach the spinal column for the surgery. And as opposed to the traditional open spine surgery where the surgeon will make a long incision straight down in the center of the spine and they will expose and dissect and might even remove some of the tissue in order to get to where they need to be.
With minimally invasive spine surgery or MISS, it is actually a technique where we use such as a tube to drop a tube down to exactly where we need to be. And that way with a tube, instead of removing muscle, what it does is it moves the muscles off to the side so we can do the surgery.
Melanie: That's so cool. So tell us about the benefit for patients to minimally invasive surgery when it comes to recovery and post-surgical rehab.
Dr. Hon Vien: Sure. So with minimally invasive spine surgery, as you know, there's going to be less trauma to the muscles as well as the soft tissue compared to open surgery. So some of these benefits include less blood loss from the surgeries, because we don't have to dissect as much muscle. There's less muscle damage because there's less cutting, which translates to faster recovery. And because of the smaller incision, there is less risk of infection as well as postoperative pain. All of this translates to a faster recovery as well as less rehab that is required for the patients. And patients, because of them having less pain, means less narcotics after surgery.
Melanie: That's a great point that you make, Dr. Vien. And so tell us a little bit about your hospital's history with spine surgery and minimally invasive and robotics. And you can also tell us a little bit about the learning curve, because as you were saying about how to find a spine surgeon, certainly with robotics and these newer techniques, there's a learning curve involved. Tell us your history and how have been your outcomes.
Dr. Hon Vien: Yes. So I came to Reid Health in 2015, and that is when I introduced minimally invasive spine surgery, as well as Mazor robotic spine surgery to Reid Health. And since then, I have done more than 500 cases with the Mazor robotic surgery using a minimally invasive technique. And patients have done very well. We've had several patients that have referred family members and friends to us for this technique. We've had patients travel from several states away in order to have this surgery.
Melanie: So then when can a patient get back to activities like driving a car? What's rehab like for patients that have had these minimally invasive procedures?
Dr. Hon Vien: Rehab in general, it's much faster compared to traditional open spine surgery. In terms of driving a car, we usually tell them to wait at least five days, just because of general anesthesia being in their system. Depending on the technique or the type of surgery also, we have restrictions for them and they can range from two weeks up to three months, especially if they have a spinal fusion with the restrictions.
Melanie: So interesting. What an exciting topic. So Dr. Vien, what do you see coming in the future of spine surgery? And as you wrap up for us, give your best advice for keeping a healthy back. You're a physical therapist, tell people how you want them to keep a healthy back so they don't need spinal surgery.
Dr. Hon Vien: In the next hopefully five to ten years, there's going to be even more advancements with robotic surgeries. Every year, there's more advancement where we can get to more of a precise location into the spine. We are using cameras to look into the spinal column. We are using even smaller incisions, smaller screws. So in the next 5, 10, 15 years, we're going to see a big leap in advancements in spine surgery.
In terms of advice for a patient, I always tell a patient, always maintain a healthy lifestyle. Always watch how you lift. Use your knees to bend and lift things instead of your back. Keep your weight down. Maintain a good core strength. Keep your flexibility in your hamstrings as well as your low back. Engage in activities every day, things that you love to do and keep your back healthy and fit. That way, you can avoid the in a spine surgeon. And if you have to find a spine surgeon, my recommendation is to look for someone that is minimally-invasive-trained and somebody that has experience with the robotic spine surgery.
Melanie: What excellent advice from an orthopedic surgeon and physical therapist, Dr. Vien. Really such an informative episode. Thank you so much for joining us today. And you can call (765) 962-4444 to schedule your appointment today, or for more information, you can always visit ReidHealth.org to get connected with one of our providers.
That concludes this episode of Right Beside You, a Reid Health podcast. For more updates on the latest medical advancements and breakthroughs, follow us on your social channels. I'm Melanie Cole.