Orthopaedic and Spine Center
When Dr. Jeffrey Carlson joined Orthopaedic and Spine Center in 1999, he was the first fellowship trained spine surgeon on the Virginia Peninsula, having completed a fellowship in Orthopaedic Trauma at Massachusetts General Hospital, and a combined Neurosurgical and Orthopaedic fellowship in Spine Surgery at Harvard’s Brigham and Women’s Hospital in Boston.
Arriving in Hampton Roads, he learned that simple discectomies were lasting an hour and a half, and disc surgeries on the neck were taking as much as two and a half hours – and both being done as inpatient procedures.
“The thinking used to be that we had to keep these patients in the hospital,” Dr. Carlson says. “But we don’t have to, and they don’t want to stay. There are risks associated with being in the hospital – bacteria, viruses and the like – and nobody really wants to be in the hospital. Patients would much rather be at home in their own environment.”
One of his first orders of business was to establish a program to teach area nurses and hospitals about micro-discectomy outpatient spine surgery, which is performed using smaller incisions, causing minor injury to soft tissue and bone, and resulting in less patient pain and a much quicker recovery. These procedures are performed in a shorter amount of time, which lessens the patient’s time under anesthesia.
Today, the majority of simple discectomy surgeries in Hampton Roads are performed as outpatient procedures, many of them in out-patient surgery centers.
Virtually all of Dr. Carlson’s cervical spine fusion cases are done as outpatient procedures, and he is now innovating outpatient lumbar fusions. “We take the disc out as an outpatient, but what about those patients that need a fusion? The thought process has always been that if we put in screws and rods, that’s a much more painful surgery, so those patients really did have to stay in the hospital,” he says. “But we can use the same incision to get the screws and rods in that we use to get the disc out, so we’re not moving muscle and tendon and irritating the soft tissue any more than with the outpatient micro-disc procedure.”
The procedure involves putting the hardware in at a different angle that grasps stronger bone. “By only touching what needs to be fixed, we can avoid having to do the painful wide dissections that have been done at the past,” he explains, “and they’re more stable.”
“We’ve done several hundred of these operations as outpatient procedures,” Dr. Carlson says, “and patients are now starting to demand it. They’re asking why they should undergo a four-hour surgery requiring a two-night stay in the hospital, when they can have the same procedure done in 90 minutes, and go home the same day.”
Dr. Carlson believes that for many surgeons, it’s as much a question of changing their mind set as it is in adopting new technologies that make these procedures actionable. “It’s a question of thinking outside of old training techniques,” he says. “It’s a question of using the best method to fix our patients’ problems as quickly and efficiently as possible, reconstructing the spine, and getting them back to doing what they want to do, in as short a period of time and with as little pain as possible.” Dr. Carlson finds as he teaches these techniques in the US and around the world that “Surgeons are adopting these techniques because they result in less injury, less pain for the patient and a shorter recovery time.”