Indications for Surgery

In order for a surgery to go right the first time, you need an idea of when spine surgery is appropriate and at what level of complexity.  There is not an operation that is effective for non-specific low back pain. For the most part then, spine surgery for lower back pain is inappropriate. There are a few exceptions to this that I will highlight as I discuss the different types of spine problems.

Surgery works extremely well for well-defined anatomic problems with matching clinical symptoms.  Another way of phrasing this is that if I can see the problem, I have a good chance of solving it.  If there are only small anatomic variations with vague patterns of pain, the chance of successfully relieving your pain is very low.

I often tell my patients that the decision to undergo spine surgery is akin to making a decision to get married.  If you have any doubt about it, don’t do it. Know Your Surgeon – Before Surgery

“Definitive” spine surgery

There is also a common attitude of undergoing a “definitive” spine operation to avoid further problems in the future.  There is no such thing as “definitive” spine surgery.  Any surgery has the potential of causing more problems in the future.  The bigger the operation, the bigger the potential complications.  The future problems caused by a major operation can be enormous and often unsolvable.  My goal in surgery is to do as little as possible to correct the problem and minimize the downstream effect.  You would not go to a dentist to have one cavity filled and then have him or her put a crown on all of your teeth to prevent future problems.

For better or worse, the spinal instrumentation and technology has evolved to the point where I can do almost anything to a spine.  You don’t really want to hear all of the possibilities.  The operations can last 6-10 hours.  Some are so complex they need to be done in two or three stages.

Minimize the impact; Maximize the Benefit

I was trained in an era before many of these procedures even existed.  So my perspective is different from someone’s who has been trained with all of this technology.  I routinely do second opinions for patients planning major procedures.  After an evaluation and discussion, I can often recommend a more minimal procedure with a more consistent outcome and fewer complications.  With the DOCC protocol, patients are able to frequently avoid surgery.

At the moment, the indications for performing a lumbar fusion or artificial disc for LBP are controversial; this controversy is as intense as any in surgery.  I hope to clear up some of these issues to enable you to make a more informed decision about surgery.

Are You Kidding Me?

BF