Making a Good Decision About Back Surgery

Surgery is a very risky procedure, and the decision to go under the knife to treat a back ailment should not be rushed.

There are three things that need to be done: 1. the exact cause of the pain should be identified; 2. you should determine how much help the surgery will be; and 3. your decision to undergo surgery should be validated by a second opinion.

Find the cause of pain

Dr. Jeff Goldstein, medical director of the Spine Service at the New York University Hospital for Joint Diseases says, "There are some patients who come in and say ‘Doc, you have to operate, I just can’t live with this pain.’ And quite honestly you have to say: ‘I empathize with your pain, and I wish I could make it better. But I don’t have a clear source for it, and I can’t be confident that surgery will help you. Surgery without having that indication may make you worse.’ "

Patients should know that their doctor has found a well-defined source of pain which is detected in an MRI or other test.

Get the complete picture

According to Dr. Richard Guyer, an orthopedic spine surgeon at the Texas Back Institute, and a past president of the North American Spine Society, patients should insist on being presented with the whole picture. Guyer says a good doctor will say, "Look, my advice is that I think you should have surgery, but the results of surgery are X and the results of conservative treatments are Y." Guyer warns though, that some surgeons do not take that approach because "we are in a specialty where we like to do things."

Be wary of the rush to operate

Lisa Brians, a California native, suffered from back pains since 2000. She recounts her experience with her doctor. "I saw a surgeon who wanted to whip me in the next day. It was very impersonal. He had seen me all of five minutes. I think it made me even more certain that that’s not the path I wanted to go down."

Dr. Roger Chou, an associate professor at Oregon Health & Science University says, "Our rates of surgery are five times higher than in the UK, and they are going up. But we haven’t shown that people in the US do better than people in other countries."

Get a second opinion

Dr. Guyer himself has had back problems. He has a rupture disk, but instead of opting to have surgery, he treated himself with exercise and anti-inflammatory medication – the same treatment plan that he would suggest to his patients. He recommends surgery when he thinks it’s appropriate, but he encourages his patients to get a second opinion.

"I don’t want to do their surgery unless they feel highly confident that they have chosen the right surgeon and if that means that they go to somewhere else, that’s fine. If they go to someone else and come back to me then I know that they are on the same page as I am. Mentally they have to be prepared for surgery."



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