Why does Dr. Bjerke not perform all procedures performed by other surgeons?
Dr. Bjerke doesn't offer patients every spine operation that may be offered somewhere else. He believes strongly in using evidence-based medicine to provide the best operations for his patients. Medical technology and the research done to track patient outcomes is constantly improving. Many providers offer procedures that have been proven to provide little benefit to patients or an inappropriate amount of risk. Dr. Bjerke will not perform these procedures, even upon request.
For the following procedures, there is little or no evidence to support the procedure, or a better alternative exists:
- Interspinous Process Spacers: Examples include: X-STOP™, Coflex™, DIAM™, and Wallis™. Similar to an interlaminar fusion, these devices are placed between the spinous processes (the visible bones in the middle of the back). Instead of performing a fusion here, they were designed to open the space and allow for more room for the spinal canal and nerves. Unfortunately, they are often unstable and lead to the same problems as an ILIF device. They are also relatively easy and quick for a surgeon to perform; unfortunately, they come with a high chance of failure and make further surgeries more difficult. There have been many studies to show the problems associated with ILIF and interspinous process spacers. (Reference: , )
- Interlaminar Fusion: This procedure involves a lumbar fusion where only the central of the spine is fused. This is also called an interlaminar instrumented fusion, or ILIF. This procedure has been attractive to some providers because it is technically relatively easy, involves a very small incision, and has very little blood loss. Unfortunately, the bones often do not fuse, and the ILIF fusion device can fracture the vertebrae, become loose, cause pain, and damage structures in the spine. Not only is this procedure often ineffective for a fusion, but also a revision surgery for fusion of the remaining bones is made more difficult by the original ILIF procedure. (Reference: )
- Discogram: A discogram or provocative discography involves injection of radiographic dye under pressure into the disc(s) under X-ray. The patient is awake for this procedure and tells the provider whether the discogram reproduces his or her symptoms. The purpose of a discogram is to find the cause of pain and determine which disc(s) is/are causing symptoms. A control discogram is usually performed on a healthy disc for comparison. Unfortunately, this procedure has been shown to lead to worsening of disc disease. It also provides little if any information that cannot be obtained from modern MRI scanners. Although some providers still offer discography, Dr. Bjerke does not recommend this for any patient. (Reference: )
- AxiaLIF™: This procedure involves a small incision near the anus to fuse the L5/S1 or L4-S1 vertebrae. Some surgeons believe this is a straightforward way to fuse bones at the bottom of the spinal column that are often the most difficult to fuse with other methods. There are several disadvantages for this: 1) it places the bowel and vascular structures at unnecessary risk, greater than from an ALIF, 2) it may cause an increase in kyphosis at these levels, which may lean the whole spine forward, 3) less intervertebral disc can be removed than in an ALIF or TLIF, which likely leads to lower fusion rates, and 4) an ALIF or TLIF are proven, straightforward methods to more safely accomplish the same goal. For these reasons, Dr. Bjerke will not perform an AxiaLIF for his patients. (Reference: , )
Dr. Bjerke will only recommend an operation to his patients that he would recommend for his family. Each procedure that he does perform is only done so after careful consideration of evidence-based medicine and what is best for each patient.