People who experience debilitating back pain come to their doctors with one pressing question: Do I need back surgery? Often, they are surprised to hear me, a neurosurgeon, answer, “No.” In many cases, physical therapy, pain management, weight loss management, and physiatry can help people to delay – and in some cases avoid – back surgery. However, if those remedies don’t work well enough, a person might decide that spine surgery is the best course of action. When that is the case, people start asking a whole new set of questions: When do I seek surgery? What type, and from whom? When it comes to spinal surgery, expertise is key. Seek out a surgeon with extensive experience performing the type of procedure you require. For example, before neurosurgeons finish their residency, they receive seven years (minimum) of training, amounting to about 2,000 surgeries, half of which are spine surgeries. Some of us go on to perform spine fellowships. For example, not only am I board-certified in neurosurgery, but I have also completed a combined neurosurgery/orthopedic spine surgery fellowship as well. While orthopedic surgeons are excellent at working with the bones of the body, neurosurgeons are trained to operate not only on the spine, but also the brain, spinal cord, and nerves. There is a comfort level with these delicate structures that explain why many primary care physicians refer their patients to neurosurgeons for spinal surgeries. It is helpful to have both an orthopedic surgeon and a neurosurgeon work together in some cases. Having two heads (and four hands) in the room can result in better outcomes for the patient. Concurrently, it is important to consider what type of surgery is right for you. Surgeons will most likely recommend a surgical approach that they feel comfortable performing. But that doesn’t always mean it’s the right approach for the patient. When you interview surgeons, ask about minimally invasive approaches and cutting-edge technology like navigation and robotics, as these can result in easier recovery times, less risk of infection, and more precise treatment. Know that most spine surgeries can be done using a minimally invasive approach. So, if a surgeon is steering you in a different direction, it might have more to do with the physician’s expertise than with your needs. It is important to advocate for yourself and seek out the best approach for you – and the surgeon who has had high success using that approach. Don’t hesitate to get a second or third opinion. For example, using spine navigation or the Mazor X Stealth Edition robotic platform, neurosurgeons here at Hoag are able to improve accuracy in spinal surgeries with less bleeding, quicker recovery time, and a greatly reduced risk of infection. I also recommend that patients look for a team-based program or institute. Patients benefit when specialists from physical therapists to dieticians and surgeons work together and confer about individual cases. Studies have found that comprehensive and personalized care significantly improves spinal surgery outcomes. Of course, the most important things to consider are your own goals. Are you an athlete who wants to get back on the field, or are you hoping to take daily walks and hold your grandchildren without experiencing pain? A person’s lifestyle can help determine the right treatment type for them. You first need a diagnosis, then a customized approach that’s right for you. Anyone experiencing debilitating back pain has a lot of questions. As someone who has treated thousands of patients, my advice is to find the medical team you trust to make sure those questions get answered. Source
