Help with Post operative Spine surgery

[gecko]

I am a pain physician working in an orthopedic practice with one spine surgeon. There was another spine surgeon working across the street from us, however, he recently passed away, and so all his patients have been directed to our clinic.

We have been trying to figure out what is the best way to see all of his post operative patients.

I wanted the opinion of a spine surgeon as to how long after surgery (particularly a fusion surgery), would the patient need to be followed by a spine surgeon? I have read on line some recommendations of up to 2 years. The spine surgeon in my practice tells me that I can essentially monitor the patient after only 3 months post op, however, I feel this is because he doesn't want to carry the burden of all his post op patients. I don't mind helping out, however, I haven't seen any post operative protocol for monitoring their fusions or any other post operative issues after 3 months post op.

What recommendations would anyone have on how to manage the referral of patient overflow as these patients have limited resources in our underserved area? At what point after surgery, do they not need to be followed by a spine surgeon anymore?

I really appreciate any input. Thanks!

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[mpp]

2-week, 1 month, 3-months and then possibly again in the 6months to 1 year time frame seems adequate. All the complications of the procedure (infection, CSF leak, pseudarthrosis) would be picked up. Even after 3 months at that point its more a followup to see if the goals of surgery were met, not necessarily to be sure there are no complications.

 

[Chronic Student]

We go a little overboard on post-op care, but it works for us.

We start out a few days after d/c from the hospital, 2 weeks, 4 weeks and then monthly to three months and then usually again at six months and then PRN.

 

[gecko]

Thanks so much for your input. I'm not too sure how to evaluate whether or not a bone graft as fully fused. Is this done with just plain radiographs with flexion and extension views to see if there is any instability? I have read some articles that a CT spine would be more precise, and some have recommended to do this at 6 months after surgery.

Also, if it has not fused completely, should I refer to a spine surgeon to see if a bone stimulator would be helpful?

If fusion is not seen, are epidural steroid injections contraindicated to assist with a radiculopathy?

Thanks again for the help! We are completely swamped now!