-By Andrew Cash, MD
Are you or someone you know considering spine surgery? Spine surgery is a big decision that comes with a lifelong commitment to the risks and results of the procedure. This article sheds light on a basic preliminary checklist that I would recommend to my patients or my family members before going under the knife.
Know Your Options
Your surgeon should identify the source of your complaints. Adults often have multiple MRI findings that are not causing pain, and a true diagnostician must identify which of the findings, if any, are generating pain in your spine. Patient complaints and their physical examination findings must be used in conjunction with imaging findings to clinically correlate the root of the patient’s pain. Many disc bulges cause pain and many do not. To simply operate on a disc bulge because it exists would lead to unnecessary surgeries with most likely poor outcomes. Surgical outcomes are improved by identifying the correct problem, performing the best procedure for that problem, and performing that surgery well. After history and physical examination are performed, to a varying degree, surgeons will order x-rays, MRIs, CT scans, nerve studies, diagnostic injections, and discograms. Make sure your surgeon has enlisted a comprehensive complement of diagnostic testings to corroborate clinical diagnoses to give him or her a solid foundation upon which to recommend a surgery and give you the reassurance that the surgery is likely to improve your condition. Although there are no guarantees with surgery, identifying the pain generator will improve the likelihood of success.
Know Your Surgeon
Surgical qualifications are variable amongst specialists. Many patients are not aware that board certification is not required to perform surgeries. Board certification is independent from state medical licensure. Please inquire with your surgeon to identify if they are currently board certified.
Fellowship training provides high-level specialization, which often translates into better outcomes and lowered complications. Please identify if your surgeon has successfully completed fellowship training in spine surgery. Patients may want to inquire how long their surgeon has been performing surgeries, how often they perform surgeries, and what percent of their practice is related to spine surgery as opposed to general orthopedics or neurosurgery.
Know Your Procedures
Knowing everything you can about your surgeon is as important as doing your homework about the types of procedures available to you, such as minimally invasive techniques. Not all spine surgeons perform minimally invasive techniques, although some perform minimally invasive techniques occasionally and some are very adept in minimally invasive and cutting-edge technology. Patients might benefit from knowing how many minimally invasive techniques their surgeon has performed; for what duration of their career they have performed them; and if they, in fact, train other surgeons to perform minimally invasive surgeries. Minimally invasive surgeries are newer developed techniques which often improve surgical success, lower complications, limit exposure to hospital stays, reduce blood loss, reduce infections, improve speed of recovery back to work and life, and decrease rehabilitation time while maintaining muscular tissue and muscular strength. The world has been gradually moving more toward minimally invasive techniques in most specialties, particularly spine. Please do not miss the boat.
Know Your Rights
Once surgery is performed, there is no undoing the surgery, which means patients are always welcome to a second and even third opinion regarding spine surgery. Please make sure you feel comfortable with your spine surgeon as your compassionate physician and as your surgical technician. If your spine surgeon is defensive about getting a second opinion or adamant that it is their way or the highway, you might want to get off at the next exit…literally and figuratively. Exploratory surgery is not optimal. With 2017’s sophisticated technology, physicians should be able to identify the source of the pain before going into surgery. Although surgery may reveal things undetected by diagnostic studies, performing surgery for the basis for learning the source of pain is guarded against.
If your spine surgeon corners you with multiple PAs, medical assistants and staff in a small room with a closed door with a consent form—making you feel like you are at a high-pressure sale after your introductory visit to a new gym—break out of the office and get to another spine surgeon.
Know About Elective Spine Surgery
Elective spine surgery is rarely curative. Often, patients might experience incomplete relief, or future pain may result in the same area due to adjacent level stresses and eventual breakdown of spinal structures. Please understand appropriate expectations without any sugar coating so you know what you are signing up for.
Elective spine surgery generally follows conservative measures like physical therapy, chiropractic and therapeutic injections. Please allow a sufficient amount of time to see if conservative measures work for you. Elective surgery is generally held as a last resort. As I said earlier, once you undergo surgery, you cannot undo the decision.
Please have your surgeon explain why surgery is a reasonable option and provide any non-surgical options. Generally, the non-surgical options include physical therapy, chiropractic, medication management, therapeutic injections, and the decision to live with the pain without any other measures.
Know When You Feel Good About Your Decision
When you are being recommended surgery, your surgeon should be able to unquestionably tell you that he or she would recommend this surgery for the same condition in one of his or her family members. Similarly, if your surgeon provides you another surgeon’s name for a second opinion, make sure this referral would met the same standard as one for the surgeon’s family members. .
The old adage that there is more than one way to skin a cat sometimes applies to surgical approaches. When your surgeon recommends a particular procedure, ask if there are different approaches and if there are variable surgical techniques to “get the job done.”
Andrew M. Cash, M.D., is a board-certified, fellowship-trained orthopedic spine surgeon specializing in neck and back care with a focus on minimally invasive operative treatments. His practice—Desert Institute of Spine Care—is located at 9339 West Sunset Rd., Suite #100, Las Vegas, NV 89148. For more information, visit www.disclv.com or call 702.630.3472.