UCSF Spine Center Offers Continuum of Care, Improves Outcomes

Back pain is ubiquitous and affects the vast majority of people at some time during life. Spinal disorders have a major impact on health-related quality of life, and represent a significant burden on our health care economy. Management of spinal disorders costs Americans more than $100 billion annually, is the third most-common reason for surgery, and is the second-leading cause of lost work time.

Complete management of spinal disorders includes a spectrum of care encompassing non-operative and operative options. Close collaboration between operative and non-operative providers is important in providing patients access to the most appropriate care for their specific condition. Many spinal disorders may be treated effectively with non-operative intervention, such as physical therapy, exercises, behavioral and occupational therapy, injections, and medications. Other spinal disorders, including symptomatic nerve compression, progressive spinal deformity, or conditions causing spinal instability, may be more effectively managed by early access to operative care. The UCSF Spine Center provides a multidisciplinary approach to the comprehensive management of spinal disorders, with the goal of providing an evidence-based approach to care.

 The UCSF Spine Center is home to a multi-disciplinary team that includes orthopedic surgeons, neurosurgeons, neurologists, cancer specialists, physiatrists, radiologists, rheumatologists, nurses, physical therapists, and pain specialists.  Our goal is to provide optimal care through interdisciplinary collaboration, and to develop optimal care pathways through rigorous assessment of our outcomes.  The UCSF Spine Center offers patients a broad spectrum of approaches to care, and guides patients to care that is tailored for their specific condition.

"Our goal at UCSF is to provide our patients with access to the highest quality of care across the continuum of non-operative and operative care," Sigurd Berven, MD, chief orthopaedic surgeon at the UCSF Spine Center, said.  "In doing so, we strive to achieve seamlessly integrated protocols at each phase of care. The end results are shared decision making, patient-centered care, and positive outcomes."

From making the decision to operate to pre-operative optimization of health status (prehabilitation), intra-operative care, post-operative management and post-discharge support, the Spine Center strives to make each phase in a patient's journey to wellness as consistent and evidence-based as possible.

Pre-operative considerations

Even when surgery is considered the best treatment choice, there is a wide range of procedures to fit each diagnosis. “At UCSF we specialize in complex spine surgery that may involve major spinal reconstruction, as well as minimally invasive procedures that can be done on an outpatient basis,” said Praveen Mummaneni, MD, co-director of the Spine Center and director of minimally invasive surgery. “This wide range of expertise allows us to guide patients to the procedure that is going to give them the best result with the fewest complications.”

When a patient has decided to undergo surgery, the Spine Center applies four standardized protocols to assessing each patient's case:  risk assessment, medical optimization, surgical planning, and physical optimization.

"Before surgery, we carefully assess the appropriateness of surgery, based upon a rigorous assessment of expected risks and benefits.  The decision to pursue surgery is a shared decision between the patient and the surgeon, and informing patients of their options, and the expected outcomes of those options, is fundamental to our effort to empower patients to make informed choices,” said Berven.

During this process, UCSF assesses specific characteristics of each patient – such as blood sugar control, body mass index, physical conditioning, cardiopulmonary factors, history of smoking, osteoporosis, nutritional considerations, and use of narcotics or other pain medications – to best optimize surgical planning.

"Having a standard protocol in the pre-operative assessment process is key to minimizing surgical risks and optimizing outcomes of care," said Berven.  "With this process in place, we create a culture of safety as a top priority for our patients.”

Intra-operative protocols, post-operative care

Once a patient is admitted for surgery, the Spine Center has a tightly defined list of protocols to ensure patients achieve the best outcomes.  Intra-operative considerations include:  blood conservation/fluid management, neuromonitoring, standard protocols for surgical techniques, and pain management to reduce complications.

Following surgery, every patient is managed using standardized protocols for early mobilization, nutritional optimization, pain management, and prevention of medical complications, such as infection, pneumonia, deep vein thrombosis, delirium, and cardiac and pulmonary problems.

Discharge planning, from arranging a patient's transportation home to planning rehabilitation and physical therapy, is also an integral component of the Spine Center's approach and its mission to providing individualized and case-based optimal care. 

"We strive to get patients mobile as soon as possible following surgery, " Berven added.  "Patients who have shorter hospital stays and a solid plan toward at-home recovery tend to have to best outcomes.  This concept is a product of our evidence-based approach to care based upon rigorous assessment of outcomes. The UCSF Spine Center offers a unique service for our community and for the Western Region, and offers great promise for improving the approach to spinal disorders on a national level."