What Are We Doing?

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I am tired of the carnage. Every week I see one to six patients who have undergone botched spinal surgeries that never had a good chance of success. Not only is the goal of surgery unattained, but the surgical trauma to the spine is often very severe. I would estimate that 50-60% of the post-spine fusions never should have been performed.

There is almost a complete disconnect in the spine care world between what we are doing and what we know we should be doing. The fallout is tragic both in societal costs and human suffering.

I am specifically referring to fusions as opposed to decompressions. A fusion is an operation that “welds” two or more vertebrae together. A decompression operation is one that simply removes pressure off a pinched nerve or set of nerves. In spite of the controversy surrounding all spine surgery, most of the time a specific nerve or set of nerves are relieved of pressure, patients feel much better. Although there might be some surgeons more aggressive than others in deciding to perform this type of surgery, most of the time the decision-making is reasonably clear-cut. If you happen to be in the minority of those patients who still have persistent nerve pain after a bone spur or ruptured disc has been removed, the downside is a fraction of that of a failed fusion, and the complication rate is lower.

As this web site matures, I will clearly delineate what I term a “structural” problem versus a “non-structural” problem of the spine. I will also list specific examples. For the moment, I am defining a structural problem as one that is clearly identifiable as abnormal anatomy on a diagnostic test and also has MATCHING clinical symptoms. Examples are: tumor, infection, fractures, active slippage between two vertebrae, and a pinched nerve with matching sciatica down the leg. Spine surgery is a wonderful structural solution to a structural problem. It does not predictably work well for vague symptoms with ill-defined anatomy. If I can see it I can fix it.

I am not against spine surgery. I am a very busy surgeon and truly enjoy being able to solve both simple and complicated spinal problems with surgery. When this happens, you are happy; I am your hero and get paid very well. There’s certainly nothing bad about that.

Conversely, I cannot tolerate the suffering of the patients I see that have had their spines destroyed by aggressive fusions. Part of the problem is that surgeons do what they are trained to do, even when the best course of action is non-surgical. The result is usually patient in worse pain. Not only is the original problem often solvable with an appropriate care program, but the patient often ends up with a spine with a structural problem—one CAUSED by surgery. These problems can be very severe, particularly when contrasted with a normal aging spine before surgery.

I can often salvage a part of your life back. I cannot give you the years back you have lost, and I cannot give you back the spine you had before you had that first operation, which had a low chance of success. You will quickly get the picture as I tell you what I see. All of the stories I will be sharing will be based on true events. Some facets of the stories will be changed to protect the identity of my patients.

One of those stories is about Marsha’s three unnecessary back surgeries.