The Scrap Heap
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Modern medicine has forgotten its foundational mission – to take care of you – all of you. The capacity to deliver high-level services for a given challenging situation is commendable and beyond reproach. Physicians’ commitment to excellence approaches unbelievable, requiring years of training, long hours, ongoing learning and just plain … Read More

Do You Really Need Spine Surgery?
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You can’t fix what you can’t see (or isn’t there)   I am publishing my book, Do You Really Need Spine Surgery: Take Control with Advice from a Spine Surgeon, this fall of 2019. I retired from my practice as a complex spine surgeon in December of 2018 to pursue this project. … Read More

Know Your Surgeon – Well
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When the DOC project began to evolve in 1999 it was my feeling that if there was a structural problem that it first needed to be dealt with surgically and then we could move ahead with the rest of the protocols. I define a structural problem as one that can be identified … Read More

Dashed Hopes
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Mainstream medicine is frequently not offering you effective care. Many procedures performed for spinal problems have been documented to be ineffective. Much of the problem stems from the corporatization of medicine where the interventions that have been proven to be effective, such as ACT (acceptance commitment therapy) (1), mindfulness-based stress … Read More

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

When will the Pain Stop?
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Mike is a local physical therapist who is a friend of mine. He has been interested in the DOC project and, like me, has struggled with severe chronic pain. I have been helping him work through different strategies to pull out of it and he is slowly coming out of … 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 often making illogical decisions regarding spine surgery. I have watched this phenomenon steadily worsen for over 30 years,     To solve a problem in the mechanical realm you must specifically identify it before you can fix it. The same holds true in your body except … Read More

Structural Sciatica Resolved Without Surgery
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When I published the first edition of my book, Back in Control: A Spine Surgeon’s Surgeon’s Roadmap Out of Chronic Pain in 2012, I was still of the mind set that if the correct pathology could be identified as the source of the pain, surgery was the best option and the sooner the better. Then … Read More

“My Son Just Died”
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George was a 78 year-old businessman who acted and looked about half his age. He was pleasant and talked freely about his LBP and pain down the side of his left leg, which had been a problem for about six months. It was consistently more severe with standing and walking, … Read More

Am I Operating on Your Pain or Anxiety?
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My surgical decision-making has dramatically changed over the last five years. In spite of watching so many successes of people healing from chronic pain without surgery, I still have a surgical mindset and am always looking for a surgical lesion that I can “fix”. In the first edition of my … Read More

Avoid Surgery by Raising the Pain Threshold
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A friend of mine asked me for an opinion a couple of years ago about his back. I was giving him advice as a friend, not as a surgeon. He was having some pain and numbness down the side of his leg. It was down the distribution of his 5th … Read More

“The Doctor is Missing Something”
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The Neurophysiologic Disorder (NPD) describes the body’s memorized response to stress and also what occurs when your body has sustained elevated levels of adrenaline, cortisol and histamines. There are many symptoms that disappear with the successful treatment of NPD. Most of them are physical. The most difficult concept for many patients … Read More

My Call to Action
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Jean was a middle-aged rancher who I saw for a second opinion from a neighboring state. She filled out an extensive spine pain questionnaire, which included many psychosocial questions in addition to a history and diagram of the pain. She was healthy and normally an extremely physically active rancher. Her low back … 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 began to perform fusions for LBP with a zeal. It was what I was trained to do.  It quickly became clear that chronic low back pain was much … Read More