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UF Health Comprehensive Spine Center · UF Health MedEd Cast

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  Melanie Cole, MS (Host): Welcome to UF Health MedEd Cast with
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  UF Health Shands Hospital.
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  I'm Melanie Cole.
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  And today, we're highlighting the UF Health Comprehensive Spine Center,
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  a multidisciplinary team of spine physicians and surgeons providing
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  a patient-centered approach to enhance outcomes through medical,
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  interventional, and surgical treatment.
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  Joining me is Dr.
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  Daniel Hoh.
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  He's a professor and Division Chief of Spine in the Department
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  of Neurosurgery at the University of Florida College of Medicine.
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  Dr.
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  Hoh, thank you so much for joining us today.
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  When we talk about spine disorders, we're really talking about a pretty
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  broad spectrum of conditions.
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  Can you give us a brief overview of the types of spinal conditions
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  that you see most commonly?
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  Dr. Daniel Hoh:
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  Absolutely.
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  When we talk about spine, as you said, we are talking about a complex array
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  of different conditions and whatnot.
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  But in reality, when we're talking about the multidisciplinary spine
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  center, what we're mostly talking about are the common types of problems
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  that affect many people that we know.
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  These are things like spinal pain related to the neck, back,
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  lower back, and oftentimes will radiate into the arm or leg.
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  And this is by far one of the most common reasons for patients to seek
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  medical treatment today from their primary care doctor, the emergency
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  room, or to be referred to our UF Health Comprehensive Spine Center.
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  Melanie Cole, MS: Well, thank you for that.
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  So Dr.
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  Hoh, as we know, pain is somewhat subjective.
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  So when patients come to you, and this is for other providers, because sometimes it
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  is the primary care who sees them first, and pain may be their primary complaint.
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  I'd like you to speak about how you approach that when they first come to
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  you and how these kinds of things can have that impact on physical function,
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  quality of life, because we all know unless you have suffered back pain,
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  it really can affect your quality of life in so many limiting ways.
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  So, speak a little bit about how they present clinically when they come to you.
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  Dr. Daniel Hoh:
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  You hit the nail on the head.
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  When we talk about the most common reasons why individuals come to
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  the UF Health Spine Center, it's typically for neck pain, back pain.
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  And pain is a quality of life issue.
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  And while you might say it's subjective, the reality is the impact
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  on quality of life can be significant.
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  And so, our goal with our comprehensive spine center is to develop a
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  patient-centered approach in how we evaluate, diagnose, and ultimately
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  treat people for the conditions that affect their quality of life.
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  It is complex.
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  And oftentimes we see patients come to us in varying stages of the problem, the
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  condition, the workup, and in treatment.
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  And our goal, like I said, is to take a patient-centered approach,
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  meaning there's not one-size-fits-all approach to these patients.
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  And so, with our comprehensive spine center, which is a multidisciplinary team
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  that includes surgeons, medical spine providers, PM&R, which is sports medicine
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  and rehabilitation, pain management.
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  We view that we have the ability to view these conditions from all perspectives
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  and then really provide a comprehensive approach to workup and provide the
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  type of multidisciplinary care that can address patients where they're at.
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  Melanie Cole, MS: So, you've just told us a little bit about the UF
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  Health Comprehensive Spine Center.
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  Tell us what makes it so unique.
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  You spoke a little bit about the multidisciplinary approach.
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  What does that pathway look like for patients?
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  Dr. Daniel Hoh:
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  So, when I think about our multidisciplinary spine center,
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  I think to myself, the condition that we're addressing is spinal
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  issues resulting in pain.
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  And really, when we think about it, we've identified what I would say is two
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  critical moments in a patient's journey.
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  The first is access to high-quality care.
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  At the point at which a patient has a problem that's affecting their quality
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  of life, can we facilitate access into our UF Health system to really be seen,
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  evaluated, and treated by some of the best doctors for this particular problem?
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  That's the first critical moment.
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  The second is we also know because of the nature of these types of
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  conditions, that sometimes the initial treatment is successful.
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  But other times, with a multidisciplinary approach, that
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  other treatments are required.
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  And so, the second critical moment is when the first initial treatment
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  does not work, how quickly are we able to pivot and provide another
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  treatment that can be successful?
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  And so, that's how we developed the spine center around this.
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  The first was ease of access, getting patients into our system
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  to be evaluated, and the second is to provide a multidisciplinary
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  approach to offer a first treatment.
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  And if that works successfully, great.
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  But if not, then we can provide other types of treatment options.
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  And so, we have a single access point, which is through a single
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  telephone number, in which patients can be referred to our center.
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  And if a patient comes with a known diagnosis or requesting to see a specific
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  type of specialty or provider, then we can facilitate an expedited appointment.
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  Alternatively, if a patient wants to just be seen and doesn't necessarily know what
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  kind of provider they want to be seen by or is in the early stages of workup,
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  we have them seen and expedited to see a provider that can initiate that workup.
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  At that point in which a diagnosis has been made and a condition, a management
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  plan has been determined, then one of our multidisciplinary spine center
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  providers will initiate that treatment.
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  Now, again, this is, I think, the second critical moment, is that if
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  that initial treatment does not succeed in resolving the patient's condition,
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  then with our multidisciplinary team, we have twice monthly conferences
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  and facilitated collaboration and communication between providers to then
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  explore other options that can then put the patient on the right course.
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  And I think that's what really allows our multidisciplinary spine
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  center to stand out from other ways in which people oftentimes end up
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  seeking treatment for spine problems.
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  Melanie Cole, MS: Well, I agree with you.
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  And Dr.
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  Hoh, one of the biggest misconceptions is that spine care
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  means either medications or surgery.
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  I'd like you to just give a brief overview of the continuum of treatment
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  options available today, because there's so many more tools in your
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  armamentarium than even just 10 years ago.
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  It's a pretty exciting time in spinal care and spinal surgery.
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  And start with a little bit of some of the conservative modalities moving into
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  some interventional pain procedures, which also have become a real burgeoning field.
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  And we'll get into some of the surgery afterwards, but just kind of give us this
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  little overview of some of the services that you offer at your spine center.
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  Dr. Daniel Hoh:
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  I think most people are pretty familiar with conventional
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  frontline conservative management.
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  These can be something as simple as initial rest after a strenuous activity
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  that may have initiated or triggered an event, but things like physical
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  therapy, non-steroidal anti-inflammatory over-the-counter medications.
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  But really, I think in this day and age, we really have a better
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  understanding of multimodal medication management treatment.
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  So, this can include things like anti-inflammatories, but in
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  addition, some other agents like neuropathic pain medications.
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  These are things like pregabalin, duloxetine that have been shown to be
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  incredibly effective and safe for the treatment of acute and chronic pain
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  in individuals with spine problems.
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  We go beyond medication management.
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  We really have a superb team of interventional pain spine physicians
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  in our multidisciplinary spine center.
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  This includes anesthesia pain management, PM&R, and neurology
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  that can offer a comprehensive array of interventional options.
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  And this can include some more conventional things like epidural
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  steroid injections or trigger point injections, some more advanced innovative
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  treatment options such as spinal cord stimulation, peripheral nerve stimulation,
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  and other types of procedures.
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  So for patients that come to our multidisciplinary spine center with
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  conditions for which they are seeking more conservative or less invasive options,
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  I know that our multidisciplinary team has the ability to offer that full
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  array of options to these patients.
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  Melanie Cole, MS: Thank you for telling us about all the options available
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  when we think of conservative measures and interventional treatments.
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  Now, tell us more about your field and some of the surgical
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  options available today.
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  There's so many, and it's pretty exciting.
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  Dr. Daniel Hoh:
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  We live in a really exciting time now in which advances in spine surgical
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  care is directly translating into improved outcomes for patients.
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  And the reality is that because we have a better understanding now of the
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  unique characteristics of patients, their condition, their priorities,
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  things that may impact risk and benefit of surgery, the ability to
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  offer a wide array of different types of surgical treatment options has
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  been never more realized than now.
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  These can range from simple, less invasive surgical treatment options
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  to address routine common conditions involving the spine, all the way up to
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  complex surgical treatment options for some of our most complicated spinal
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  conditions like spinal deformity or revision surgery for failed prior surgery.
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  Our surgical team has a broad range of surgeons with varying experiences
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  and expertise in all these different areas with regards to surgical
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  advancements in spine surgical care.
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  We have a multidisciplinary surgical meeting in which we meet twice monthly
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  and review cases to discuss as a group what is the best treatment option,
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  whether it be surgical or non-surgical.
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  But certainly, if it's surgical, what are the different types of surgical
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  approaches that may best fit the needs of that particular patient?
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  Melanie Cole, MS: Well, they certainly do.
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  And Dr.
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  Hoh, you've spoken a few times about the integrated comprehensive
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  multidisciplinary model.
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  What does the literature tell us about that impact on outcomes
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  when you are all working together?
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  Dr. Daniel Hoh:
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  I know that a team approach that offers comprehensive multidisciplinary
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  care has been proven to be effective and better than single siloed care
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  for a number of medical conditions.
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  We know this is certainly true when it comes to things like cancer care and
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  other types of complex medical conditions.
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  And we certainly see this when it comes to spine care.
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  I'll use one example.
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  We first started looking at how we can optimize care for the perioperative
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  surgical patient undergoing spine surgery.
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  And we learned early on that collaboration between anesthesiology and neurosurgery
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  and spine surgery and physical therapy and rehab for both preoperative
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  and postoperative optimization would have a significant impact.
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  And we ultimately implemented a multidisciplinary collaborative
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  protocol for the optimization of patients undergoing spine surgery.
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  We ended up studying this and publishing in multiple journals showing, through
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  various studies, that a collaborative multidisciplinary approach can optimize
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  patients undergoing spine surgery to reduce adverse events, reduce length
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  of stay, facilitate earlier recovery of function, and improve overall outcomes.
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  We even explored this looking at our most vulnerable populations.
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  So, these are patients that have frailty, and we found that frail patients,
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  generally speaking, typically do worse than patients that are non-frail.
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  And yet, when we implemented a multidisciplinary approach for
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  optimization, patients even with frailty improved and did nearly as
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  well as patients without frailty.
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  So, that really bolstered us and gave us the understanding of how a
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  multidisciplinary approach can really improve outcomes for our patients.
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  Now, what we do see with our Multidisciplinary Spine Center is that,
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  without a doubt, things like patient satisfaction, throughput, meaning
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  that patients get access to care and access to the treatment that they need,
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  happens in a much more facilitated way.
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  We also know that by through collaboration, that the ability of our
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  physicians to work together to identify the best treatment for a patient
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  typically happens more efficiently and in a more expedited manner.
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  Melanie Cole, MS: Well, it certainly is a comprehensive approach.
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  And while we talk about this multidisciplinary approach really
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  looking at the team that is working with these patients, Dr.
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  Hoh, how important is shared decision-making with the patient
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  themselves in helping them to understand their options because
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  there are so many, and to participate in choosing the treatment strategy
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  that aligns with their goals?
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  Dr. Daniel Hoh:
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  That's a great question, and I think perfectly aligns with the
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  philosophy and approach of our center.
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  When we're talking about quality of life, paramount to that is
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  an understanding of what an individual patient's priorities are.
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  What's most important to them?
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  We can look at MRIs, we can look at X-rays, we can look at our array
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  of treatments, and we can say, "Here's what we have available
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  to us to offer to the patient."
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  But at the end of the day, the goal of this is to address what's
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  most important to the patient.
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  So when we look at a patient-centered approach, what we really mean is, can
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  we make the right diagnosis, identify the right set of options for management,
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  present that to a patient in a way that makes sense, and say which of
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  these, based on their advantages and expected risk and benefits, most aligns
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  with their individual priorities?
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  There's no question that given the diversity of the patients we see and the
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  variation of types of conditions we see, that we cannot assume that one treatment
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  works for all individuals or that even one treatment works for different
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  individuals with the same condition.
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  Each patient comes with their own priorities, their own expectations
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  for what is a best overall outcome.
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  So, patient-shared decision-making, I think, is paramount to that.
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  And I think that starts with an open discussion in the clinic.
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  What is most important to you?
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  What is most important to your family?
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  And with that sort of discussion, then oftentimes the types of options
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  for treatment fall in alignment.
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  Melanie Cole, MS: Dr.
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  Hoh, you've given us so much to think about and such great information.
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  If there was one message you'd like clinicians, referring clinicians,
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  and patients to take away about modern spine care today and the UF
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  Health Comprehensive Spine Center, what would you like them to know?
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  Dr. Daniel Hoh:
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  What I would say is that the condition of spine pain when it manifests as
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  neck pain and back pain is a really significant issue for our communities.
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  The UF Health Multidisciplinary Spine Center is dedicated to
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  providing the utmost premier level of care for our patients.
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  If you have patients that you feel are suffering from these conditions, we would
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  be honored to have them referred to our center so that we can expedite access to
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  care and provide that multidisciplinary approach of patient-centered care to give
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  them the best outcome that they deserve.
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  Melanie Cole, MS: Thank you so much, Dr.
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  Hoh, for joining us today and sharing not only your incredible
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  expertise, but your passion for the Spine Center and for what you do.
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  I can hear it, and thank you so much again for joining us.
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  To learn more about this and other healthcare topics at UF
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  Health Shands Hospital, please visit innovation.ufhealth.org,
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  or to listen to more podcasts from our experts, please
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  visit ufhealth.org/medmatters.
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  That concludes today's episode of UF Health MedEd Cast.
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  I'm Melanie Cole.