Outpatient Cervical and Lumbar Spinal Fusion Research: Q&A With Dr. Jeffrey Carlson

Jeffrey Carlson, MD, is an orthopedic spine surgeon and the president and managing partner of Orthopaedic and Spine Center, in Newport News, Va. He is also the chief of surgery at Bon Secours Mary Immaculate Hospital in Newport News. Dr. Jeffrey Carlson of Orthopaedic & Spine Center

A pioneer in using new technologies to improve spine surgery, Dr. Carlson was one of the first surgeons in his area to perform a cervical disc replacement in 2008. He recently led the effort to bring computer-assisted knee replacement technology to Hampton Roads and is breaking new ground in the field of spinal osteotomy. He is a prolific author and researcher, and has also contributed research on arthritis of the spine and the efficacy of using bone grafting for spinal fusion.

Dr. Carlson received his medical degree from George Washington University in Washington, D.C. He completed his residency at Harvard University, and finished his fellowships in orthopedic trauma surgery and orthopedic spine surgery at Massachusetts General Hospital and Brigham and Women's Hospital, respectively.

Here Dr. Carlson details his current research on cervical and lumbar fusion.

Question: What is the main focus of your current research?

Dr. Jeffrey Carlson: Currently we are working on outpatient cervical and lumbar fusion surgical interventions. Most spine fusions are done as inpatient procedures due to the pain and dysfunction created by the surgery itself. There have been many efforts to improve lumbar fusion surgeries but all have led to increased surgical times and increased risks of complications or inadequately addressing the patient’s problem with the surgical technique. Minimally invasive surgery is somewhat of an overused term and has meant multiple things over the years. The basic idea in what we are doing is combining the effectiveness and shorter surgical times of open surgical techniques with less disruption of the soft tissues. The biggest focus is decreasing the pain of the procedure itself.

Q: What techniques or innovation have you been exploring?

JC: We have long been performing outpatient surgery for disc herniations in the neck and lower back. The pain from these procedures can be managed outpatient. We thought we could use the same surgical exposures to perform fusion surgeries in the neck and back. The techniques we are exploring, involve the same amount of soft tissue disruption as these known "smaller" procedures, but adding the more complex and invasive element of placing screws and rods through the same disrupted tissue. Using the same incisions that we know allow outpatient procedures, we can decrease the need for the more extensive exposure of soft-tissue and bone that leads to more pain for more complex procedures. Anesthetic techniques with multiple medication combinations and advances in spinal hardware have allowed us very encouraging early success.

Q: Have you drawn any conclusions?

JC: So far, we are able to show significant improvement in pain and dysfunction after surgery that has allowed us to send our cervical and lumbar fusion patients home within a few hours of surgery. Patients are very pleased with the results. They are able to recover at home. There is no need for intravenous pain medications and none of the nausea associated with the parenteral narcotics.

Q: Why did you choose to research cervical and lumbar fusion?

JC: Patients have been pressing for less pain after surgery. We have been dissatisfied with minimally invasive procedures that mean the surgeon makes a small incision but then disrupts large amounts of soft-tissue, takes twice as long to do than the open procedure and patients still have the same pain and dysfunction requiring a hospital stay. In this vein, we have taken up the cause to provide a better way for patients to return to their activities and lifestyles more quickly and not have to stay in the hospital. Our population is very driven to be productive and our patients don't want to be slowed down by medical issues. We are trying to address these larger spinal surgeries, as they are some of the more invasive procedures that seem to take more time to recover leading to losses in productivity at the job and home.

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