The Surgical Mindset: Anatomy Dictates Therapy

By | March 7, 2015

The presence of an area of consolidation, the radiographic sign of pneumonia is important to your primary care physician, but its exact location usually is not.  If cancer were suspected as a cause of this pneumonia, surgeon looking at such an X-ray would care more about the location than the size, because some areas are easily resectable while others are not.

The presence of an area of consolidation, the radiographic sign of pneumonia is important to your primary care physician, but its exact location usually is not. If cancer were suspected as a cause of this pneumonia, surgeon looking at such an X-ray would care more about the location than the size, because some areas are easily resectable while others are not.

We have spoken before about the intricacies and complexities of medical decision-making all of which apply in the consideration of surgical therapy. However complicating surgical decision-making is the additional factor of anatomy. Most medical therapy is based on physiology and pathological processes which are the same for an entire organ or organ system. A good example of this would be seeing your primary care physician with “walking pneumonia.” While a chest X-ray is likely to be ordered to confirm the diagnosis of pneumonia by demonstrating the presence of an area of consolidation, it really makes very little difference in therapy whether that consolidation is in the left upper lobe, the right middle lobe or the lingual. But if we change the scenario slightly so that we are now visiting a thoracic surgeon for the treatment of a small cancer, now different anatomy may dictate different surgical approaches, outcomes or possible complications. An example that we see quite often at Schlesinger Pain Centers is radicular back pain which we will exam in much greater detail in later blogs. This type of back pain is usually due to lumbar disc disease, but which may also be due to foraminal stenosis. The initial injection therapy, a lumbar epidural steroid injection (LESI) is not greatly changed by whether the nerve root compression is due to soft tissue in the case of disc disease of boney overgrowth in the case of foraminal stenosis, but the surgical therapy will certainly be affected. In the next several blogs we will look at the basic types of pain syndromes, as well as the variety of anatomical derangements that can give rise to them and only then will we look at the different surgical approaches.


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