“We treat the patient, not the disease”, states the orthopedist Maia Gonçalves, director of Hospital da Luz Arrábida Spine Unit. In an interview where he reveals how the team dedicated to this pathology operates in the largest Luz Saúde hospital in the North region, the specialist explains the importance of experience and clinical differentiation in the success of the diagnosis and treatment of spine diseases. “We are a unit of reference, we were pioneers in procedures that are today the golden standard in the area, and we count on a multidisciplinary team always focusing on the best result for the patient”, he declares. The pathology of the spine is one the most frequent causes of work absenteeism among younger people and deterioration in the quality of life among the older ones. And Hospital da Luz Arrábida counts with the best professional and technological resources, and with an experienced team of specialists in the multiple valences integrating the diagnosis and treatment of any spinal pathology – the patients being studied and treated by a multidisciplinary team, engaged in finding the best solution for their problems. In that sense, Maia Gonçalves takes the opportunity to leave a message: “Do not underestimate complaints. Seek for differentiated care. And do not resort to ‘Dr. Google’ or friends to treat problems that can be serious. In medullary or sciatic pain, and other spine symptoms, it is fundamental to seek differentiated care in units of reference. Our Spine Unit at HL Arrábida has the adequate experienced and dedicated professional resources, and cutting-edge technological resources”. How to know what specialist to choose in the case of spine symptoms? The teams of Orthopedics in hospitals are typically organized by “parts of the body”, making it relatively easy for patients facing a particular symptom to identify which specialist they should resort to. This corresponds to an increasing sub-specialization in different areas, which enables a higher experience of professionals and a greater capacity of diagnosis and treatment. The same happens regarding spine pathology, which is also currently a sub-speciality of orthopedics. But it is also a sub-speciality of neurosurgery. Now, it is important to make this clear: orthopedists and neurosurgeons dedicated to spine pathology do the same. We are all spine surgeons, although coming from different specialties, and we treat patients similarly. As for the choice, it should fall on centers of reference, units such as our Spine Unit (at Hospital da Luz Arrábida), where the goal is to achieve the best results for every patient, depending on their specific condition, through a multidisciplinary teamwork that has the latest technology at its disposal. How did the Hospital da Luz Arrábida Spine Unit come about? Hospital da Luz Arrábida is fortunate to have the capacity to accept highly complex cases in terms of treatment. And considering the increasing number of cases we were receiving, we felt the need to create a more agile internal clinical organization, that would favor synergies between the four specialists dedicated to the area, and at the same time facilitate the collaboration with the other areas that are essential for the diagnosis and monitoring of patients with spine pathology. Always in view of offering our patients a better service, we proceeded to create a Spinal Unit, which is what we have now. We are a team of spine surgeons, physiatrists, therapists, specialists in pain treatment, radiologists, and many others. Our goal is to provide the patient, according to his pathology, diagnosis and problem, a network of healthcare that will allow him to get the best result. Arriving at the HLA Spine Unit: what to do? There are symptoms indicating that one should seek a spine specialist: lumbar or cervical pain, persistent back pain refractory to treatment, lumbago, sciatic pain irradiating to the lower or upper limbs and associated to lack of strength and tingling… These are the main reasons that lead patients to look for our help. There are significant referrals from colleagues of General and Family Medicine and from the Emergency Service. Naturally, not all these common situations require the permanent intervention of the Spinal Unit. And much of the pathology of the spine that we assist does not involve surgical treatment, but it’s up to us to decide that orientation, viewing to improve the condition of the patient. What exams are usually performed to diagnose the pathology of the spine? The Spinal Consultation always requires differentiated exams. Besides the physical exam and inquiry on the patient’s history, more differentiated exams are necessary to reach a more precise diagnosis. CT and cutting-edge magnetic resonance are the exams that ensure a safer and more qualified diagnosis of spine pathology. In addition to classical X-rays. Cutting-edge technology, like the one we have at HL Arrábida, which offers us a morphological imaging of the spine and an almost perfect definition of the spinal structure, will allow us to make an accurate diagnosis and determine the therapeutic orientation for each clinical case. And here, the quality of the exam and of the obtained imaging is essential. In the HL Arrábida Spinal Unit, we have at our disposal such advanced equipment, and we work closely with the HL Arrábida radiology team to reach faster solutions for our patients. Is surgery always the treatment in spine pathology? Surgery is a useful and important treatment, but it involves precise indications. Meaning that in certain diagnoses, in certain spine diseases, the treatment is clearly surgical. But in many others and much more frequently, that is not the case. Surgery always views to solve a problem. But in some cases, surgery does not solve the problem. Hence the importance of detailed examination and careful assessment, to ensure the best result for the patient. We do not treat the disease; we treat the patient. Why are patients so afraid to undergo spine surgery? This is an urban myth! Of course, we are talking about delicate structures and surgeries that require great precision. But they are extremely safe, I can guarantee. This is important to stress: a good indication is the result of the surgery. We will always have good results when the indication for surgery is the correct one. On the other hand, for that result, the decision as to surgical technique to apply in treatment is also fundamental. And here there is a very important aspect at play: the differentiation of the team, and the fact that it works in the context of a Spinal Unit which is integrated in a hospital environment, having all the medical and surgical valences. Now, that is precisely what we have, I stress once again, at Hospital da Luz Arrábida: a unit where a team working collectively manages to have enough scale, experience, and methodology to obtain the best results with the lower rates of complication. Is minimally invasive surgery the most common treatment technique in spine pathology? It is in fact the most common treatment when the indication is surgical, for instance in pathologies with disc herniation or narrow canal herniation. These are actually very common pathologies among the Portuguese population. And I can say that over 90% of the surgeries I perform are minimally invasive. Who integrates the team of the HL Arrábida Spine Unit? Besides the four spine surgeons, we work in multidisciplinary with preferential stakeholders from every area involved in the treatment of this pathology. Thus, we can provide fast responses to our patients, at every step of their diagnostic and therapeutic journey. And we take decisions in multidisciplinary coordination. What distinguishes the HLA Spinal Unit, in terms of complexity and differentiation? There are two areas where our unit stands out. On one hand, the minimally invasive surgery: we are pioneers in spine endoscopic surgery; we were pioneers in a series of other minimally invasive techniques commonly used today; and we perform surgery resorting to highly advanced technological resources, such as state-of-the-art microscopes for navigated surgeries, also highly differentiated. On the other hand, in large-scale surgery, in cases of axial deviation, scoliosis, kyphosis, and more severe pathologies, we also have large experience and are a clinical reference for many years now. SUCCESSFUL CASES I had a patient – who was CEO of a German company and highly differentiated – that came to our Unit to undergo a minimally invasive cervical surgery. He was operated on in the morning and, in the afternoon, when I went to see him in his room, he was sitting at the computer. I asked him how he felt. He answered that he was just about to buy another company! All I know is that right after that, when he was discharged from hospital, he went straight to the airport, for he needed to sign the papers for the acquisition that same day. Another patient that struck me was Mrs. Deolinda, who suffered from a very severe spine pathology. She was still a young woman, in her 60s, but who lived with her back bent. The deformation of the spine was so severe that it stopped her from walking and leading a minimally normal life. Mrs. Deolinda was submitted to a highly complex surgery, involving procedures such as bone cutting for the alignment of the spine, but it led to a very satisfying result. A few days after the operation, she was already walking down the hospital aisles with her back straight. And afterwards, she was able to resume her normal life in a very different way from before the intervention. These are two examples that impressed me, from different extremes of the spine pathology: in one case, a quite simple surgery, which struck me for the swift return to activity and everyday life; in the other case, a very complex intervention, with a highly gratifying result in the gain of mobility and quality of life.
