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CLINICAL OPINION
Multidisciplinary approach improving spinal outcomes By Dr Greg Cunningham, Spinal Surgeon, Murdoch Advances in spinal surgical technology with changing population demographics has led to an increasing rate of spinal surgeries of approximately 5% every year. This acceleration necessitates advancement in preand post-operative care. Enhanced Recovery After Surgery (ERAS) protocols were first reported in the 1990s, pioneered post-operatively following colorectal surgery. Publications on care improvement now span surgical disciplines. The newest ERAS protocols for spine surgery incorporate pre- and post-operative treatment, acknowledging the journey can be enhanced long before theatre. Modern ERAS protocols in spinal surgery can include pre-operative: Prehab physiotherapy, patient/ carer education with home/ occupation assessment and the input of a pain specialist, physician or clinical psychologist depending on circumstances This multidisciplinary biopsychosocial approach reduces pain, disability, kinesiophobia and
Key messages
Enhanced Recovery After Surgery (ERAS) can expedite recovery after spinal surgery A perioperative biopsychosocial approach is used to improve outcomes A similar approach has been adapted for non-operative patient management.
anxiety/depression. Pre-surgery physiotherapy can decrease pain, risk of avoidance behaviour, and worsening of psychological wellbeing improving quality of life and physical activity. Anecdotally, in our practice, we see improvements with patients rapidly engaging with allied-health providers with whom they are already familiar, knowing exactly what to expect after surgery expediting their recovery. Post-operatively, the sooner spinal-surgery patients mobilise, the less oral analgesic/antiemetic medications is required and the shorter their hospital stay. Patients having simple decompressions to
complex multilevel fusions can be mobilised on the day of surgery, facilitated by their pre-operative training and education. Multidisciplinary care is vital for non-surgical spinal patients too. Input from pain specialists, rehabilitation physicians, physiotherapists and clinical psychologists improves patient outcome measures and functional/ occupation return. Treatment involves individual goal setting, addressing fear-avoidance behaviours and self-management strategies, promoting self-efficacy and sustainable long-term outcomes. The latest multidisciplinary approaches encompassing the biopsychosocial patient model demonstrates improved patient outcomes shorter hospitalisations and faster functional return. – References available on request ED The author acknowledges the input of Ceri Pritchard and Hayley French in the writing of this update.
Professor Richard Naunton Morgan — General Surgeon MBBS FRCS AMC FRACS
South Perth Hospital is pleased to advise Professor Richard Naunton Morgan, General Surgeon, has commenced a General Surgical service. Professor Naunton Morgan consults at 72 South Terrace, South Perth. Consultation bookings: 0466 342 100 Postal address: PO Box 214, Como WA 6952 Professor Naunton Morgan and his anaesthetist are no gap providers.
MEDICAL FORUM | MUSCULOSKELETAL ISSUE
OCTOBER 2020 | 37
