Another Interesting NYC May meeting

[ans]

Woudn't mind getting a hard-copy of this Symposium asap.

(The Kineflex disc's results among other info. w/be discussed):

https://www.blueskyz.com/SAS2005/program.asp

[Mariaa]

Me too. I see that Delamarter's office is presenting something on surgical outcome as reported by WC patients vs. Non WC patients.
I'm glad I didn't have surgery there yet as I'm WC.
Back when Dr.Dawson headed the office and I saw him for a 3level global fusion consult, he actually took the resident aside in the hall and told him "this is a WC patient. The studies show that WC patients don't report getting better because of secondary gain." I was so mad when I heard that as he returned to my examing room I told him that I worked 20 years after my WC original injury...
Anyway, back to the overall presentation, it looks really super~ Mark are you going to attend this also?

[mmglobal]

This will be my 3rd Spine Arthroplasty Society conference.

Mark

[ans]

Mark, if a member, do you know when you'll get a hard-copy of the Symposium vs. abstracts? Thanks - Allan

[mmglobal]

Not sure.

[Mariaa]

Mark,
I saw two topics of interest and am wondering if you can correct me if I'm wrong in what I'm thinking...

date 5/5/05 8:25 a.m.
Stretch Neuropraxia after anterior lumbar fusion or ADR placement~

This about injury to the nerve during the stretch for distraction? Is there something that can be sprayed or applied to the nerve to perhaps make it more flexible/stretchable.. is this a really stupid question..

5/7/05 10:12a.m.
Using Cortoss TM for Prevention of Artificial Disc Subsidence (Fedrico Giradi)

Is this one of the types of substances used in vertebroplasty to prevent subsidence after ADR? Are there any that are able to be utilized in vertebroplasty in the US during ADR?

A few other questions I would have liked to posed if attending the NYC big Spiney event besides the above would have been if someone (like myself) has nerve root scarring (mine is at rt. S1) can anything be done about this at the same time ADR is being done?
Also, does someone that already have nerve root scarring have a lesser chance of having a successful outcome with ADR because possibility of this pain becoming enhanced after more surgery?

Also is the standing on ADR with an adjacent disc that has annular tear less than Adams Grade IV still considered to become more stable with adjacent disc replacement?

Perhaps this isn't the correct place to pose these questions and if so, I apologize~ these likely should go elsewhere, maybe under the other NYC conf. on May 1....

I'm guessing these types of questions except maybe the one about already existing scar tissue on nerve root will pop up and be discussed...

Thanks for reading this~ wish I were attending the NYC conf. on May 1.. I know I'd gain so much pertinent info and likely have all questions answered as there are so many spine experts attending, it's a slam dunk for all I think...

[ans]

I still am struck by how important some of the topics are - including the ones you mention.

[gary]

Maria.....
i don't understand the difference of a wc patient vs non wc patient, what is meant by the comment?

[wbaker68]

Statement is like any other personal injury related claim, patients tend not to feel better until the claim is settled. I actually believe its not necassarily related to financial gain but relief that the entire process is over. There are of course the cases where one is afraid to feel better for chance of not getting a bigger recovery but I feel its mostly psychological and not meant to be the way it looks.

Not sure if I explained well enough?

Take care, Bill

[lisa]

actually from what I've seen the claim that Worker's Compensation patients have a worse surgical result is not a robust finding. Some studies, like my surgeons, show equal results, some show worse results and one study showed it was the contested cases that had a poor result, the uncontested cases did as well as non work comp. but doctors will tend to remember the studies that fit with their worldview

part of the problem is that correlation is not the same thing as causation especially in complex multidimensional things like surgery. There some fairly obvious factors that can explain poorer results for workers comp other than secondary gain

1) it generally takes longer to get diagnosed and longer to get surgery in workers comp and that leads to the poor surgical results. I've seen one study indicating this to be significant for work comp.

2) work comp in California now offers almost no physical therapy. Most patients would get no after surgery PT at all.

3) economic class is a significant issue. If you have to go back to the work that injuried you without modification too soon after surgery or can't afford help at home for tasks that would be aggravating to your spine after surgery, you don't get good as good surgical results.

as far as I can see, the studies don't show people getting markedly better after the claim settles, which is the finding that would be expected if secondary gain was the significant factor.

(under the new ca law, a failed one level back surgery that leaves you bedridden I think nets about $12K before the attorney gets paid, which isn't a lot of secondary gain. most back injuries pay less than that)

sorry for the rant, misuse of statistics by doctors is kind of the pet peeve of mine