Surgeon in focus – Alok Sharan

Surgeon in focus – Alok Sharan

Alok Sharan is an orthopaedic spine surgeon who focuses on minimally invasive spine surgery, as well as cervical spine surgery. He is one of the leading authorities on the Awake Spinal Fusion procedure. Currently, he serves as the director for spine and orthopaedics at
NJ Spine and Wellness in New Jersey, USA

 

 

SSN: As a specialist in spine surgery, could you tell us more about your experience and training background in this field?

AS: I am an orthopaedic spine surgeon, having been in practice for 14 years. I completed my spine surgery fellowship at NYU/Hospital for Joint Diseases.

 

SSN: What drove you to choose surgery as a career – and spinal surgery in particular?

AS: Spine surgery is an evolving field. There are still many aspects of spinal disorders that remain unanswered. I enjoy the challenge of performing a surgery that can deliver a great impact on patient care, while being involved in a field that continues to evolve.

 

SSN: You have pioneered the awake spinal fusion procedure. Can you tell us more about it?

AS: Awake spinal fusion represents the next advancement in minimally invasive spine surgery. The goal of minimally invasive surgery is to perform a spine surgery with as minimal of an incision as possible that leads to an overall faster recovery.

We performed a study a few years ago that demonstrated how profound an effect general anaesthesia had on the elderly in terms of cognition and delirium. We started moving all of our lumbar spine surgery towards regional anaesthesia, avoiding general anaesthesia.

The surgery hasn’t changed – just the anaesthesia technique. In addition, we also modified our pain management regiment to minimise opioid usage. Ultimately, awake spinal fusion is an enhanced recovery protocol that allows a patient to recover faster, mobilise quicker, while minimising opioid usage.

 

SSN: Has there been any research conducted and what have the results shown?

AS: We have presented our results in multiple forums now (AAOS/NASS). Our first major publication was recently printed and you can read the article by visiting: www.sciencedirect.com 

 

SSN: How does awake spine surgery benefit the patient experience?

AS: Improving the patient experience will be the next great challenge in spine surgery. Spine surgeons will soon have to face the reality that the consumer and patient have changed. Patients want to have their pain taken care of quickly, in a minimally invasive and less destructive manner. 

Using our awake spinal fusion protocol, we find that patients are less likely to feel nausea/vomiting after surgery. Since many patients do not take narcotics, they do not feel constipated. Overall these things lend itself to a better experience.

We are currently experimenting with different methods to improve the experience during surgery. Many of our patients come into the operating room with headphones to listen to music. We are finding that these patients come out of the OR with less fear and anxiety, which is leading to an overall improved surgical experience.

 

SSN: Is it suitable for any type of patient requiring lumbar spine surgery?

AS: At this point, we are performing awake spine surgery on the majority of our lumbar spine surgeries. The only patients that cannot handle this are the ones who cannot tolerate being prone for two to three hours.

 

SSN: What are the advantages of using this technique?

AS: Avoiding general anaesthesia, especially in the elderly, leads to tremendous improvements in post-op recovery. We are finding that our patients have less nausea and vomiting after surgery. In addition, since many patients are off narcotics, they are less constipated. Their recovery is overall faster.

 

SSN: How could this change the future of minimally invasive spine surgery?

AS: As spine surgery moves away from inpatient towards outpatient, we have to begin to look at all the factors that lead a patient to stay in the hospital after their surgery. We believe that avoiding general anaesthesia, using some new regional blocks in the spine, can enable many lumbar procedures to be done on an outpatient basis.

 

SSN: How do you think the future looks in the field of spine surgery?

AS:  The future of spine surgery is bright. As the population gets older, it is clear that there will be a greater demand for spine surgeries. There are tremendous advancements currently in the field including robots and navigation. As spine surgery becomes safer and ultimately a better experience, there will be a greater demand from patients who want to get their life back quicker.

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