Introduction

Patients frequently inquire about success rates, complications and various aspects of proposed surgical procedures. The information available to patients is usually anecdotal and frequently even the surgeon is unable to provide more than an educated guess or provide generalities based on the academic literature regarding potential risks and benefits. Even with this information the patient is unsure how any individual surgeon’s experience correlates with these benchmarks.

For the past 10 years I have recorded surgical cases, patient outcomes, significant complications, re-operations, etc…. primarily as an educational tool for myself. By measuring my own surgical success I have periodically re-evaluated the results and modified patient selection, and the surgical techniques performed. Hopefully this has resulted in greater surgical success and fewer failures.

In an effort to provide this information to my patients I have compiled the last 1000 surgical procedures and categorized them into relevant groupings. This represents approximately the past 5-6 years and, given the changes, which occur in treatment protocols, is a group which remains representative of current practice.

The remaining 150 procedures consist of multiple procedures including biopsies, posterior cervical fusion, cervical laminectomies, removal of instrumentation, thoracic fusion, thoracic discectomies, thoracolumbar fusions, and anterior/posterior thoracic and lumbar fusion procedures.

The indications for these procedures vary widely from fracture to deformity, tumor, etc…. As such, the groupings are small and diverse.

The following is a compilation of patient outcomes for each procedural group. Success is measured as relief of the patients primary complaint which in almost every case was some pattern of pain or dysfunction.

Patient outcomes have been divided into four groups.

Excellent, Good, Fair, Poor.

Excellent represents complete or near complete relief of pain with unrestricted activity level.

Good represents significant relief of pain with minor symptoms present with certain activities but insufficient to result in significant limitation of activities.

Fair represents patients with improvement of pain but who remain symptomatic with activities, which continue to be limited to a significant degree.

Poor represents patients with no significant improvement in pain and little or no improvement in activity level.

Excellent and Good results are considered successful. Fair and Poor results are considered failures even though fair may represent improvement to some degree.

More recently I have developed and adopted a numerical scale to provide a more sensitive and objective tool by which to measure our outcomes. It will be 1-2 years before a significant number of patients can be reported using this methodology.