By Dr. Kingsley Chin
Introductory content by Fabio Pencle
A newly published study has demonstrated that patients prefer a midline incision for cervical spine surgery.
The anterior approach to cervical spine surgery has become the standard for the treatment for degenerative disc, traumatic herniated disc and fracture dislocation. Cloward, Smith and Robinson have
devised operative techniques with modiﬁcations by several surgeons since 1958. There are varying types of skin incisions for cervical spine surgery; the incision is either on the right or left side of the trachea based on the surgical approach to the recurrent laryngeal nerve. Other factors determining the type of incision include a few pathological levels aﬀected, if corpectomy is required and whetheraﬀected segments are contiguous.
Transverse midline incisions have been used by other surgical specialties such as ENT, vascular and general surgeons. This incision provides a more cosmetically acceptable result and allows for access to structures during surgery; however, few studies discuss the relevance of cosmesis. There are several named guidelines for determining surgical incision, most notably, Langer’s lines. A transverse midline incision would, however, follow the guideline by Kraissl, where the incision is made in a skin crease. The quality of surgery is judged immediately by the amount of relief of symptoms and the cosmetic.
Considering the patient-driven procedures oﬀered to treat the same pathology, as well as recent trends in the increase in ambulatory surgery center (ASC) use, the authors felt it prudent to devise a questionnaire with the primary goal of determining the preferences of the patients. The secondary goal was to determine factors which lead to the decision to have anterior cervical spine surgery.
Fabio J.R. Pencle, Jason A. Seale, Amala Benny, Sephania Salomon, Ashley Simela, Kingsley R. Chin
To read the full paper & citations as published in the Journal of Orthopaedics, visit here.
Authors aim to determine patients’ preference for surgical incision and factors affecting the decision for surgery to the anterior neck.
A questionnaire was presented prior to evaluation and if preceded to surgery followup given.
243 patients completed questionnaire, with 60% female population and younger than 50 years. 151 patients preferred a transverse midline incision with a statistically significant increase in outcomes and cosmesis importance and a decrease in the importance of board certification.
Findings of questionnaire demonstrate that patients’ prefer a transverse midline anterior neck incision, with surgical outcomes being the overall factor affecting decision making.
About Author Dr. Kingsley R. Chin
Dr. Kingsley R. Chin is a board certified Harvard-trained orthopedic spine surgeon and professor with copious business and information technology exposure. He sees a niche opportunity where medicine, business and info. tech meet – and is uniquely educated at the intersection of these three professions. He has experience as Professor of Clinical Biomedical Sciences & Admissions Committee Member at the Charles E. Schmidt College of Medicine at Florida Atlantic University, Professor of Clinical Orthopedic Surgery at the Herbert Wertheim College of Medicine at Florida International University, Assistant Professor of Orthopaedics at the University of Pennsylvania Medical School, VisitingSpine Surgeon & Professor at the University of the West Indies, Mona, and Adjunct Professor of Clinical Biomedical Studies at the University of Technology, Jamaica.
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Less Exposure Surgery (LES) is based on a new philosophy of performing surgery, leading the charge to prove through bench and clinical outcomes research that LES treatment options are the best solutions – to lowering the cost of healthcare, improving outcomes and increasing patient satisfaction. Learn more at LESSociety.org.
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Scientific Paper Author & Citation Details
Fabio J.R. Penclead, Jason A. Sealead, Amala Bennyd, Sephania Salomond, Ashley Simelade, Kingsley R. Chinabcf
a. Less Exposure Surgery Specialists Institute (LESS Institute), United States
b. Herbert Wertheim College of Medicine, Florida International University, United States
c. Charles E. Schmidt College of Medicine, Florida Atlantic University, United States
d. Less Exposure Surgery (LES) Society, United States
e. Bronx Lebanon Hospital Center, United States
f. University of Technology, Jamaica