The FUSION Word

• May 8, 2017

Phoenix Spine is pleased to provide our blog readers with the following entry written by Board Certified Neurosurgeon, Dr. Dan Lieberman. His unique perspective and insight will help you understand how DVR (Direct Visual Rhizotomy), a new “ultra minimally invasive” spine procedure can help you live pain free, without the risks and complications of traditional spine surgery.
So, you’ve had back problems for years. It has finally become so severe you’re fed up and actually saw a surgeon about it, and they recommended a spinal fusion. You then talked to two family members: a cousin who had spinal fusion and now feels great, and an aunt who tells you “never ever have back surgery”.
Who is right? The fact is, probably both of them.
Our philosophy at Phoenix Spine is to solve your back-pain problem in the least invasive manner possible. This has made us a highly desirable spine surgical practice in the greater Phoenix area, especially for those who want to avoid spinal fusion. On the other hand, I’ve also done thousands of fusions over the years, and I have seen how the operation can really change lives. At this point my opinion of fusion is similar to your family’s: I have mixed feelings about the operation. It all depends on what’s wrong with you. For some problems, fusion is the answer. For others, we now have better options.
Table 1 is a short list reasons that people may need spinal fusion. For the conditions in the right column, fusion is a Godsend. Some of these— like tumor and fracture— are fortunately very rare. On the other hand, for all the conditions in the left column, we now have a better option: Direct Visualized Rhizotomy or DVR.

Not Apples to Apples
So what are some of the differences? DVR is an outpatient procedure that never requires a blood transfusion, take 15 – 20 minutes, and patients are usually fully recovered in 1-2 days. If you have the procedure Friday you are back to work on Monday. We are closing in on our first 1000 cases at Phoenix Spine, and so far we haven’t seen any major complications.
With spinal fusion, a hospital stay is often required as well as a blood transfusion in some instances. With a fusion, recovery is 3-24 weeks, depending on the surgeon. Fusion can be complicated by misplacement of hardware, infection, nerve root damage, as well as other risks associated with major surgery, like pneumonia, urinary tract infection, and blood clots.
Given the options, patients always choose DVR over fusion, because of the lower risk, quick recovery, and they can avoid having implants in their body.
DVR has really changed my patient’s lives, and thereby changed my practice (see graph below). I started doing DVR in 2012, and for the next several years I tracked the number of DVR procedures I performed (orange) and compared them to the number of fusion surgeries (blue). There are still some people who simply need a fusion to address their issues, however you can see how DVR really became the procedure of choice for many patients and replaced a great deal of spinal fusion cases in my practice.
So is fusion right for you? It is possible, but these days there’s a good chance DVR is a better option. Our job at Phoenix Spine is to figure out what’s wrong, so we can do only what is right for you. The whole process begins with a phone call to our office so we can help.

So is fusion right for you? It is possible, but these days there’s a good chance DVR is a better option. Our job at Phoenix Spine is to figure out what’s wrong, so we can do only what is right for you. The whole process begins with a phone call to our office so we can help.