Avoids a Five-level Neck Fusion
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I received this email from a physical therapist on the East Coast, who I’ve never met. He’d heard about my work on a podcast. Before you read this letter, I’d like to emphasize that research has documented for decades that arthritis, bone spurs, disc degeneration, disc bulges and herniations are … Read More

Prehab – Optimizing Surgical Outcomes
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“Prehab” is refers to a patient engaging in a rehabilitation process before surgery. There are well-documented factors that affect pain and surgical outcomes. It’s important to implement treatments to address all of them prior to undergoing a procedure with significant risks. Chronic pain infiltrates every aspect of life. You have … Read More

Comprehending the Downside of Spine Surgery
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No one thinks that a surgical complication will happen to them. During my spine fellowship, I witnessed a large number of major complications and I was sure that I was going to be better than them – even though they were considered some of the top spine surgeons in the world. … Read More

It is Becoming Harder to Make a Living as a Surgeon………
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In late March this year I received this email from an educator in the South. I don’t recall how he found me. Dear Dr. Hanscom, Is there a doctor or clinic in the Nashville, TN area that you would recommend? I have ordered your book and look forward to the … Read More

Eight-Level Spine Fusion? No!
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A seventy-three-year-old woman—let’s call her Dorothy for the sake of this story—was understandably apprehensive. She had just been told that she needed an eight-level spine fusion from her tenth thoracic vertebra to her pelvis, so she came to me for a second opinion. Dorothy was a retired National Guard armed … Read More

Surgery is the Definitive Solution?
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Ernie presented to me a few years ago with severe back and leg pain. He had undergone two spine fusions for LBP about 10 years earlier that had not been helpful. His three lowest vertebra had been fused from L4 to the sacrum. Additionally, he now had severe leg pain … Read More

Optimizing (Avoiding) Spine Surgery
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About three years ago my staff noticed that our surgical patients who participated in the DOC project principles were doing much better. The outcomes were better and we were having fewer failures. The postoperative pain seemed less and more easily controlled. Patients were moving forward quickly with rehab while re-entering … Read More

Are You Kidding Me?
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Patients and physicians are not making logical or reasonable decisions regarding spine surgery. I have watched this phenomenon for almost 30 years and it’s getting disturbingly worse.     To solve a problem in the mechanical realm you must specifically identify it before you can fix it. The same holds … Read More

Am I Operating on Your Pain or Anxiety?
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My surgical decision-making has become a clearer over this last couple of weeks – but in an unexpected way. I have noticed this year that many patients with significant structural anatomic problems will improve or resolve their symptoms without surgery after engaging in a self-directed structured approach. It appears that … Read More

How Many More Neck Surgeries?
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One middle-aged patient sought me out in Seattle from the East Coast for a second opinion regarding his neck. He had been disabled since 2001 with chronic pain over most of his body. He had at least 10 additional NPD symptoms of burning, aching, stabbing, and tingling that would migrate throughout … Read More

My Early Surgical Philosophy
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I started my practice in Seattle in 1986.  I was feeling pretty beat up from my spine training. I felt well-trained and still had a rather high opinion of myself,  but I was tired.  It also quickly became clear that low back pain was much more complicated than I had … Read More