VA Maryland Health Care System
Introducing The Spine Board
There's power in numbers. A tumor board review enables doctors who are experts in a number of different specialties to review and discuss the medical condition and treatment options of patients with a challenging tumor. And now, similar to the objectives of a Tumor Board, the VA Maryland Health Care System is applying a comparable strategy for patients who've undergone surgery but continue to experience back pain. Enter, the multidisciplinary Spine Board, an innovative approach to address the complex medical, physical, and mental health needs of dealing with chronic low back pain. Within the Spine Board, a group of specialist in various aspects of lumbar spine care gathers to discuss the best clinical options to help patients with lower back pain.
"The VA Maryland Health Care System Spine Board includes representatives from pharmacy, primary care, anesthesiology and pain management, physical therapy, radiology, psychology, in addition to the surgeons," said Dr. Khodadad Namiranian, an anesthesiologist who was inspired to establish the group after realizing that a multi-disciplinary team of experts discussing the most challenging cases can determine the best possible outcomes for patients with spine and back pain that may or may not include surgery. "The Tumor Boards were designed for better team dynamics and communication, improved patient satisfaction, and improved clinical outcomes, and the same approach can be applied to those struggling with lower back pain," he added.
In addition to Namiranian, other clinical leaders who help found the board includes Drs. Celeste Lombardi, Gregg Jolissaint, Eugene Koh, Douglas Turner, Edward Norris, and Sandra Marshall, the chief of staff for the health care system. "The board will meet monthly to discuss the most challenging cases to develop the best treatment plan for the patient. With so many medical experts focusing on one case and with everyone reaching a consensus about the treatment plan, the outcome can only be a treatment plan that speaks to the best interests of the patient with all the involved medical services in agreement," Namiranian said. "If there is a pressing case, the members can communicate via email (encrypted email for privacy) to discuss the particulars to arrive at the best decision that would most help the veteran," he added.
"This is an excellent way to illustrate what we mean by patient-centered care." said Dr. Sandra Marshall, chief of staff at the VA Maryland Health Care System. "With experts from a number of clinical programs all focused on an individual's case, we're confident that the team approach will identify the best treatment options available for that particular Veteran. It speaks to our core goals of caring for the whole person."
The goal of the Spine Board is to improve the recovery and rehabilitation of veterans wanting elective spine surgery. This means, said Namiranian, doing the correct surgery for the correct patient at the correct time. "The number of lumbar spine surgeries has nearly doubled between 2000 and 2012, and the incidence of post-laminectomy syndrome increases significantly with repeated surgeries," he said.
Lower back pain---attributed to a third of work-related disability—cost Americans $86 billion in 2005, representing 65 percent increase from 1997. "The issue is that the incidence of pain increases significantly with repeated surgeries," said Namiranian.
The Spine Board's other goals include ensuring that the patients selected for surgery experience the best outcomes, developing optimal plans for preoperative preparation, which can lay the foundation for improved recovery and rehabilitation from surgery. The Spine Board also aims to identify obstacles for lower back pain recovery and better communication between all the clinicians involved in spine care of the patients. "Improved communications between healthcare providers involved in spine care can identify other conditions that might cause lower back pain but which might not be related to spine issues," said Namiranian.
"Another important goal for the Spine Board is to help maximize the non-operative management of patients with low back pain," said Dr. Celeste Lombardi, director of the Outpatient Interventional Pain Service at the VA Maryland Health Care System and an appointee member of the Maryland Board of Physicians. "Part of this process includes addressing patients' mental health needs and starting a management plan months prior to a planned surgery, to optimize their post-operative surgical outcomes. It is well known that patients with pre-operative depression and chronic low back pain are less likely to experience improved quality of life from lumbar spine surgery," she said.
Also, Lombardi added that patients with anxiety disorder and depression are also more likely to experience chronic pain and seek medical attention. "This is why the founding team of the multidisciplinary Spine Board includes the valuable expertise of a clinical pain psychologist," she said.
Considering that the Spine Board consists of a multidisciplinary group of experts agreeing on the most optimal treatment plan for each patient, for veterans suffering from chronic lower back pain and post laminectomy syndrome, the prognosis can only be good.