April 6, 2022

Never Have Back Surgery

I hear it all the time: “I will never have back surgery."

As a spine surgeon, I am always humbled to operate on a patient’s back. Patients
depend on the success of the procedure, and I respect the overwhelming apprehension
surrounding back surgery. People trust others and their opinions–when someone hears about a
bad experience with back surgery, it influences their perception of the procedure. So, I try not
to be offended when people tell me they’ve heard back surgery doesn’t work. If that were the
case, I would never and should never operate on anyone! Might as well close up my practice
and do something else. Right?

The reality is, spine surgery can be life-changing–in a good way–if the correct surgery is
matched with the right condition. Research and experience have enlightened spine surgeons as
to which surgeries work and which do not. I use this knowledge to filter through many patients
with painful spinal problems, finding treatments that work for them, whether that includes
surgery or not. Most conditions will not require an operation, as they can often be treated with
exercise or other pain management regimens. In fact, I may see 100 patients a week and only
recommend surgery to 10 of them. In other words, 90% of patients in my clinic do not need
surgery. Selectivity drives better results.

Another factor unique to the spine is that it isn’t just one joint, like a hip, knee or
shoulder. In fact, just the lumbar spine, or the low back, has 5 vertebrae connected by 10 joints
called facet joints, as well as 5 discs. This complex structure was elegantly designed to protect
the delicate spinal nerves and allow movement through all those aforementioned joints. It is
part of what makes us human. Unfortunately, gravity is not kind to the spine. Over time, the
spongy discs and fluid joints wear, causing spurs to develop. These spurs, or overgrowths of the
spine, can narrow and pinch the nerves. As a result, if I operate on one of the five levels of the
spine, there are 4 more which may go bad or cause problems down the road. My former
partner Dr. Lehman used to tell his patients, “spine surgery is like potato chips–you can’t just
have one!”

Joking aside, spine surgery can feel like a failure if another level goes bad sometime
after surgery. But it’s important to recognize that the surgery didn’t fail, the spine did. This
sounds discouraging, but it shouldn’t be. Because there are multiple spine levels, there is no
guarantee another level won’t cause problems later in life. Spine surgery is not a one-size-fits-
all treatment–in a multifunctional interlocking system like the spine, your muscles, bones and
nerves can affect one another. The spine allows for movement, flexibility, structural support
and protection. And as it withstands not only the forces of gravity but your daily behavior and
activity, natural and traumatic injuries can occur. Possibly requiring future surgery doesn’t
mean the initial procedure failed, especially because surgery can accomplish many other goals,
like reducing wear on your spine, relieving your pain and allowing you to resume the activities
you love.

Our procedures aim to do just that. miiSpine’s minimally invasive spine surgery
techniques decrease the rate of wear on the neighboring spine levels. By accessing the spine
through small windows and causing minimal disruption of normal anatomy, we can preserve
the adjacent levels, thereby decreasing the need for further surgery. Furthermore, a minimally
invasive approach generally promises quicker recovery times and better patient outcomes. This
has been proven in many studies, and I have noticed the difference in my own practice.

The bottom line is, you should only resort to surgery after exhausting all other
treatments. Are you following an anti-inflammatory diet? Are you exercising? Are you doing the
right exercises? Did you try physical therapy? Did you try shots? Medicine? If you tried
everything and the pain is unbearable, that’s when you should consider surgery. I often wait for
patients to reach this conclusion on their own and tell me when they are ready. After all, it’s
your body. Once you have surgery, I will do my best to give you back that quality of life you are
missing. The greatest part of my job is hearing positive feedback from satisfied patients. So, the
next time someone tells you to never have back surgery, make your own judgement call.

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