A Step-by-Step Guide to Making a Good Decision About Back Surgery

Dr. Jeffrey Goldstein recommends that patients make sure their doctor has found the source of their pain.(JEFFREY GOLDSTEIN)There are of course many success stories with back surgery, but surgeons counsel that the decision should not be rushed. The precise cause of the pain needs to be identified, the potential for surgery to help quantified, and the decision should be validated by a second opinion.

Find the cause of the pain

"There are some patients," says Jeffrey Goldstein, MD, medical director of the Spine Service at the New York University Hospital for Joint Diseases, "who come in and say 'Doc, you have to operate, I just can't live with this pain.' And quite honestly you have to say: 'I empathize with your pain, and I wish I could make it better. But I don't have a clear source for it, and I can't be confident that surgery will help you. Surgery without having that indication may make you worse.' "

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Patients should know that their doctor has found a well-defined source of the pain that shows up in an MRI or other test: a herniated disk, for example, or spinal stenosis (a narrowing of the spinal canal generally caused by osteoarthritis).

Get the complete picture

Patients should insist on the full story, says Richard Guyer, MD, an orthopedic spine surgeon at the Texas Back Institute, and a past president of the North American Spine Society. Guyer says a good doctor will say, "Look, my advice is that I think you should have surgery, but the results of surgery are X and the results of conservative treatments are Y." But he cautions that not all surgeons take that approach, because "we are in a specialty where we like to do things."

Beware the rush to operate

Lisa Brians, from Moss Beach, Calif., had suffered from back pain problems since 2000. "I saw a surgeon who wanted to whip me in the next day. It was very impersonal. He had seen me all of five minutes. I think it made me even more certain that that's not the path I wanted to go down."

"Our rates of surgery are five times higher than in the UK, and they are going up," says Roger Chou, MD, associate professor at Oregon Health & Science University. "But we haven't shown that people in the US do better than people in other countries."

Seek a second opinion

Guyer has a ruptured disk but decided not to have surgery, treating himself instead with exercise and anti-inflammatory medication as he would suggest to his patients. He believes in surgery when appropriate, but he counsels all his patients to seek a second opinion.

"I don't want to do their surgery unless they feel highly confident that they have chosen the right surgeon and if that means that they go to somewhere else, that's fine. If they go to someone else and come back to me then I know that they are on the same page as I am. Mentally they have to be prepared for surgery."

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