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  • Changing Perspectives: The Concept of Feasibility and Bioethics in Spinal Surgery

    Final Number:

    Laura Ganau; Lara Prisco MD; Daniele Pescador; Andem Effiong BS; Joe Raho BA; Mario Ganau MD MSBM

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Although spine surgery has been the first specialty to tackle the rising ethical problems of conflict of interest and financial disclosure, the practical dilemma between feasibility and bioethics while making difficult therapeutic choices involving fragile patients has rarely being addressed.

    Methods: The topic of bioethical choices in spine surgery has been addressed with special attention to life-threatening spinal traumas or spinal metastases and their impact on quality of life (QoL). The analyses have been conducted by means of: review of the English literature, and interviews within a cohort of elderly or cancer patients and their close relatives.

    Results: In the 1990s, evidence-based medicine emerged as a way to improve and evaluate patient care; however to date the systematic review of large randomized controlled trials has shown a lack in providing recommendation on treatments for elderly and cancer patients. A total of 40 interviews were recorded from patients with reduced life expectancy due to their age or pathological conditions. We asked how they would face a serious traumatic or metastatic spinal disease, that was still surgically treatable but not curable, and likely to compromise their QoL in some way: 80% would opt for ethical consultation prior to deciding whether to accept or reject treatment, 15% would refuse further treatments, and only 5% did not respond.

    Conclusions: Combining the best research evidence with the patient's values would enhance decision making on how to properly diagnose illnesses, choose the best testing plan, and select the best treatments and methods of disease prevention. Nevertheless, it is difficult to adopt practice guidelines for every single patient. Based on the information obtained from our interviews, neurosurgeons and ethicists should work in a coordinated fashion to resolve dilemmas involving complex medical and legal cases, with the goal of achieving resolution and consensus regarding the appropriate delivery of healthcare.

    Patient Care: Advocating the suitability of ethical consultations in providing the tools to achive the most correct decision making process in complex neurosurgical cases

    Learning Objectives: By the conclusion of this session participants should be able to - identify those patients requiring a more comprehensive approach - describe the importance of ethical consultation in clinical practice


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