Frequently Asked Questions

• Q: Why are spinal surgical procedures so expensive?
• A: Health care costs are on everyone’s mind and all of us – patients, physicians, government, insurers, and employers among others – want to find every way possible to rein in medical expenses. At Twin Cities Spine Center, we are committed to doing everything possible to minimize the cost of health care without compromising the quality of care.

That said, it is important to recognize our physicians’ primary consideration is – and will always be – the best care for their patients. It’s also a simple truth that some spinal surgical procedures are inherently expensive; they require the services of expert surgeons, physicians, nurses and other medical professionals, they are often extraordinarily complex and delicate and they often involve the use of expensive, precision-made devices. Such surgeries are best done – in fact, can only be done – in well-equipped, full-service hospitals and medical centers that add to the cost of care, but that also provide a margin of safety that significantly improves the likelihood of a favorable outcome.

• Q: Who are good candidates for spinal surgery?
• A: Every patient – like every person – is different; they have different perspectives and wishes, their bodies are unique in stature, in function and in terms of the ability to withstand the effects of surgery and in their ability or willingness to participate in rehabilitative programs. Because of these variables – and a dozen more – there is no “one size fits all” answer to such questions. What we can say, though, is that the vast majority of patients who experience back pain do not require surgical procedures as their symptoms generally resolve themselves with either little or no intervention. Because of this fact, our approach to any treatment recommendation is conservative and based on a “step-by-step” method that begins with a focus on non-invasive treatments and that progresses to surgery only after nonsurgical measures have not given a patient adequate relief.

• Q: What is a spinal fusion?
• A: Spinal fusion permanently fuses or joins two or more vertebrae in the spine. This fusion is accomplished with a variety of materials and devices such as bone grafts, plates, screws, rods, or cages.

• Q: Why would a doctor recommend a spinal fusion?
• A: A doctor might consider spinal fusion if a patient is experiencing severe pain, a substantial loss of functionality or a decreased quality of life that cannot be treated successfully through non-invasive methods. Some conditions that could lead to such a recommendation include:
  • Scoliosis, a curvature of the spine
  • Kyphosis, a “humpback” deformity of the spine
  • Spondylolisthesis, the forward slippage of a segment of the spine
  • Spinal stenosis, narrowing of the spinal canal typically from arthritis
  • Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
  • Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear

Recently, some of the leading organizations in the area of spinal surgery and research jointly authored a letter, available here, on the appropriate use of spinal fusion procedures. While every patient is different and every circumstance should be diagnosed and treated based on its specific factors, we support these general guidelines.

The guidelines were the product of review by the American Association of Neurological Surgeons, the American Association of Orthopaedic Surgeons, the Congress of Neurological Surgeons, the AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves, the International Society for the Advancement of Spine Surgery, the North American Spine Society, the North Carolina Neurosurgical Society, the Pediatric Orthopaedic Society of North America and the Scoliosis Research Society.

Again, it’s important to keep in mind that every individual’s case is different and treatments are always specific to the individual patient. Surgery is considered only after nonsurgical measures have not given a patient adequate pain relief, improved functionality or improved quality of life.

• Q: What type of nonsurgical treatment do doctors offer patients prior to considering spinal fusion?
• A: Again, every patient is different but, generally, those who are candidates for surgery have tried a number of conservative measures including:
  • Rest and restricted activities.
  • Over-the-counter medications for pain management.
  • Prescribed medications for pain management.
  • Physical therapy and chiropractic treatment, different forms of exercise.
  • Cortisone or other anti-inflammatory injections.

• Q: How many spinal fusions do the surgeons at Twin Cities Spine perform?
• A: The ten Twin Cities Spine Center surgeons perform approximately 1,300 spinal fusions a year, a number that has been very consistent over the last three years even as the practice has grown. These spinal fusions are performed for various conditions including:
  • Scoliosis, a curvature of the spine
  • Kyphosis, a “humpback” deformity of the spine
  • Spondylolisthesis, the forward slippage of a segment of the spine
  • Spinal stenosis, narrowing of the spinal canal typically from arthritis
  • Radiculopathy, the irritation and inflammation of a nerve caused by a herniated disk
  • Degenerative disk disease, the development of pain in a disk as a result of its normal wear and tear

• Q: Why do Twin Cities Spine Center surgeons do so many spinal fusion surgeries?
• A: While the majority of the surgery performed at TCSC do not involve spinal fusions, there are a number of situations where fusion is appropriate. It is widely recognized that the success rates for most complex medical procedures (i.e cardiac surgery, joint replacement, transplant care, etc.) are best where performed in experienced, specialty centers. TCSC is a major referral center, annually serving patients from over 25 states and even other countries. Our physicians are uniquely recognized as leaders in their field and many referring physicians entrust the care of their most difficult patients to our center.

• Q: What is the success rate for spinal fusion surgeries?
• A: “Success” means different things for each patient, but the vast majority of fusion patients experience substantial improvement in their quality of life, in their day-to-day functioning and in terms of pain relief. We hear this from our patients, see it reflected in the patient surveys we conduct and read about it in numerous scientific studies conducted by researchers across the industry.

Our surgical patient satisfaction results are posted on our website and can be found here.

• Q: What are the risks associated with spinal fusion surgery?
• A: Like all medical and surgical treatments, spinal surgery carries a number of risk factors. These include the possibility of infection, bleeding and nerve damage as well as medical complications such as heart attack, stroke, blood clots, paralysis or death.

Fortunately, serious complications of spine surgery at Twin Cities Spine Center are exceedingly rare. Collectively, our surgeons have over 175 years of experience (far more than any other group of spine surgeons in the area). We make sure that our patients are fully informed about the risks associated with any procedure, the pros and cons of alternatives and also about the steps we take to minimize the possibility of such risks becoming realities. In all cases, we strive to make sure every patient has all of the information he or she needs to make an informed decision regarding the available options for care and treatment.

• Q: What devices do Twin Cities Spine Center surgeons use in spinal fusion surgery?
• A: Our surgeons use the device(s) that are most appropriate to each patient’s circumstances and that will provide the best outcome. There is a wide range of products and devices that our physicians are familiar with and use effectively. Our surgeons do not exclusively use the devices made by any one manufacturer.

• Q: What is the relationship between Twin Cities Spine Center doctors and medical device manufacturers?
• A: Twin Cities Spine Center physicians are active in their careers with education, training, research and the development of new implants and improved surgical instruments and techniques. As part of this work, our physicians may receive industry-standard compensation for their contributions to the development of new products and input on research and development. Some may give instructional lectures on spine surgical care, implants, and surgical techniques to other physicians and medical personnel.

In an effort to avoid any potential conflict of interest, to maintain the highest degrees of integrity and to provide complete transparency in this area, Twin Cities Spine Center seeks to exceed the highest industry and professional standards with respect to our disclosure of relationships.

Some companies provide limited financial support for the extensive research and education programs that Twin Cities Spine Center sponsors. It’s worth noting here that our surgeons receive no payments, royalties or any other form of compensation for using any device, including those to which they contributed intellectual property and/or on which they hold patent rights.

Further, our physicians receive no royalties on any product used by anyone at any of the hospitals where they have privileges. In other words, even if a surgeon with no connection to this practice uses such a product at any of these hospitals, TCSC physicians receive no royalty payments or other compensation from that use. In this way, product choice (or even procedure choice) is not influenced by royalties or relationships with device manufacturers.

• Q: Are Twin Cities Spine Center patients made aware of the relationship between Twin Cities Spine Center and medical device manufacturers?
• A: Yes. Every patient who comes to Twin Cities Spine Center is given a “Financial Disclosure Letter” as part of their registration and consent forms:

   

  Dear Patient,

  As you prepare for your care at Twin Cities Spine Center (TCSC), we want to provide you with some information regarding our financial arrangements with several companies that may be directly or indirectly involved in any treatment or care that might be recommended for you.

  TCSC physicians are active in their careers with education, training, research and the development of new implants and improved surgical instruments and techniques. As part of their work, they work under contract with orthopaedic companies providing consulting services on new products and input on research and development. In addition, they give instructional lectures on spine surgical care, implants, and surgical techniques to other physicians and medical personnel. Some companies also provide financial support for the extensive Research and Education Programs at TCSC. In return for their time and expertise, our physicians may receive various forms of payment that are consistent with government acknowledged industry standards. Payments may include medical directorships, royalties and/or consulting fees.

  Consulting fees, royalties, medical directorships and other financial support may be received from:

  • Abbott Northwestern Hospital

  • Biomet Spine

  • BlueCrossBlueShield of MN

  • Depuy Axial Biotech

  • Medtronic

  • NuVasive

  • Orthopaedic Development Company

  • St. Francis Regional Medical Center

  • Stryker Spine

  • Synthes Spine

  • Zimmer

  Our office uses products and services from these companies in the care of patients but also uses similar products and services from others as well. We want to assure you that the selection of any product or service for your care – and the care of all of our patients – is based only upon what is best for the patient – not on which company makes the product. In no case or circumstance do TCSC physicians receive any form of payment from these companies for anything related to your care.

  It is important to each one of our physicians that you are aware of these financial relationships and our absolute commitment to placing the health care interests of our patients first and foremost. We are available to answer any questions that you may have about this disclosure.

  The entire package is also available on our web site here.

• Q: With what companies or entities do TCSC surgeons have relationships?
• A: Twin Cities Spine Center has business relationships with the following organizations
  • Abbott Northwestern Hospital
  • Biomet Spine
  • BlueCrossBlueShield of MN
  • Depuy Axial Biotech
  • Medtronic
  • NuVasive
  • Orthopaedic Development Company
  • St. Francis Regional Medical Center
  • Stryker Spine
  • Synthes Spine
  • Zimmer

• Q: Do Twin Cities Spine Center surgeons use any products in their practice that they helped to develop?
• A: Our surgeons use in all cases the best available devices and techniques that offer the greatest chance of achieving positive outcomes for their patients. When those factors indicate the use of a specific device, that device is used. Our surgeons, however, receive no payments, royalties or any other form of compensation for using any device, including those to which they contributed intellectual property and/or on which they hold patent rights.

Further, TCSC physicians receive no royalties on any product used by anyone at any of the hospitals where they have privileges. In other words, even if a surgeon with no connection to this practice uses such a product at any of these hospitals, TCSC physicians receive no royalty payments or other compensation from that use. Therefore, product choice (or even procedure choice) is not influenced by royalties or relationships with device manufacturers in any way.

• Q: Does Twin Cities Spine receive funding from outside entities to support its fellowship and research programs?
• A: Our fellowship and research programs receive limited amounts of funding from outside of the practice. By far, the largest source of funding for both the research and fellowship are the practice’s partners themselves. Over the last two years, the members of the practice have contributed in excess of $400,000 of their personal resources to both programs as part of their commitment to improving the skills and knowledge of the profession.

In an effort to maintain the highest degrees of integrity and transparency in this area, most orthopaedic implant manufacturers have partnered with independent third parties to fairly collect, administer and distribute industry-supported education and research funding. For example, the Orthopaedic Research and Education Foundation (OREF) now independently administers such programs for most orthopaedic fellowship training and research, including spine surgery. We support these initiatives.