Surgically Profiling Yourself

Spine surgery has a poor reputation. Many people know patients who have undergone multiple surgeries and have ended up crippled. However, spine surgery can also be seemingly miraculous in giving a patient her life back. There are some principles you should be aware of that have a major influence on the outcome of surgery. You can and should know exactly where you fit into the spectrum.

There are two sets of variables that affect the decision to undergo spine surgery.

  • The first set is the type of anatomic problem that is causing the pain. Is it a structural lesion clearly identified on a diagnostic test? Or is it a soft tissue non-structural problem that cannot be seen on a diagnostic test?
  • The second issue is whether you are under a significant amount of stress, which may or may not be related to your pain. If you are under a lot of stress and not coping well, it has been shown in hundreds of articles that your outcome from surgery will be compromised.

The resultant set of choices regarding surgery falls into one of four categories.

Low Stress

A

High Stress

B

Structural Lesion

I

IA

IB

Non-Structural Source

II

IIA

IIB

I was asked to give a talk at a national spine meeting in 2006. The topic was the surgical selection of patients for spinal surgery. The goal of the talk was to convey how I personally select patients for surgery. It was while I was putting the talk together that this classification system came about. It represents the internal paradigm I use when I am deciding whether to perform spine surgery. I now incorporate this model into many conversations regarding the best way to treat spinal pain. Eventually, I hope this system will be validated and I assume there will be subgroups that will come out of future research. At the moment, it is most useful to help conceptualize decision-making regarding treatment. Please look at the “Surgical Classification” post to look at this classification system.

BF