If you suffer from chronic back pain due to a herniated disc then you’ve likely considered a number of treatment options including back surgery and physical therapy (PT).
Both options, of course, cost time and money. While most health insurance plans will (at least partially) cover spine surgery like spinal fusion, microdiscectomy, and disc replacement, the amount they cover will vary. Determining which plans cover which kinds of PT, under what conditions, and at what price, may be even harder to discern. On top of that, different states have different requirements and different insurance companies offer a variety of plans.
All that to say…
It’s not always easy finding the right healthcare to cover your back pain needs
Thankfully, the internet makes this process easier by helping us determine which treatments and which health insurance plans may be the best fit for each of our specific needs.
Listed below are three different websites with health insurance comparisons to help you find the right coverage. As a “bonus”, we’ve even added two more websites to help you find the closest doctor or physical therapist who best suits your needs.
Top 3 Websites to Help You Compare Health Insurance Benefits
- eHealth Insurance. It offers quotes for a number of different types of insurance and the interface is relatively straightforward. Click on the “health” tab and then answer about half a dozen questions including age, zip code, height, weight, and household income. You will eventually be given some health insurance options in your area to consider. You will have to navigate to the actual health insurance company websites for specifics.
- Consumer Reports. Consumer Reports is the consummate shoppers guide offering reviews and comparisons for all variety of goods and services. Their health insurance page is pretty straightforward. Click on the drop down menus to choose your preferred plan type (HMO, PPO, etc.) and your state. It will display a list of clickable plans ranked in order of consumer satisfaction, treatment coverage for common conditions, and providing preventive services.
- Healthcare.gov. Whether or not you think it’s a worthwhile government endeavor, it looks like the “Patient Protection and Affordable Care Act” (or “Obamacare”) will be around for a while. If you’re considering enrolling, then this is the website to hit. Upon entering your zip code, you will either be directed to your state government’s health insurance website or, if your state doesn’t have one, directly to the federal government’s health insurance website. Once there, you can find the plans that are available to you and easily compare them.
Now that you’ve found the right healthcare plan, you need to find the right provider!
When it comes to finding a good spine surgeon or physical therapist, patients have traditionally relied on their primary doctor’s recommendation or word of mouth from friends, family and colleagues. Once again, the internet can help you in your research. A quick Google search can often help locate a nearby provider. However, if you’re looking for a bit more information, you may want to check out Yelp or Zocdoc.
Find the Right Doctor with These 2 Websites
- Yelp. Most people are already familiar with Yelp but if for some reason you’re not, jump on now. Yelp is a consumer-driven website that allows you to check out ratings and reviews for most any good or service – including surgeons and physical therapists. Just enter your hometown and type in what you’re looking for (eg. “spine surgery”, “discectomy”, “physical therapy”, etc.). A list of local practices will pop up within seconds. You can then sort these results by user rating and read reviews for more information. Some businesses even offer discounts and the ability to book directly through the Yelp. It couldn’t be easier!
- ZocDoc. Similar to Yelp except it focuses exclusively on doctors and other health care services. Just enter the specialty you’re seeking and your hometown and Zocdoc will quickly produce a list of doctors or therapists along with consumer ratings. If you already have insurance, you may enter your provider’s name anytime to see which spinal surgeon or physical therapists are covered. ZocDoc shows available appointment windows for each office and you can book directly through the website.
As with any major healthcare choice, especially if you’ve been experiencing severe chronic back pain, it’s best to consult a doctor.
Seeking a second opinion on your back pain treatment?
Contact us or call us today at 855-377-4767
“I know. I’ll get right in the middle of the dance floor where everybody can see me and impress Monica Banner with my amazingly limber and athletic dance moves.”
Those were the thoughts of my 17 year old, awkward, girl-crazy self right before I leapt in the air, arched my back, felt a pop, and came down right near Monica’s feet. Suffice to say the excruciating physical pain didn’t compare to the embarrassment. I lay on the ground for about three minutes as classmates gathered and eventually helped me off to the side where I lay motionless for my parents to arrive.
Ouch, my pride.
One of the guys who helped me off would later date and marry lovely Monica. He was better looking, more athletic, and a pretty decent guy by most accounts. I still don’t know what she saw in him..
An orthopedic surgeon soon informed me that I had a herniated disc in my lower back between the L-4 and L-5 vertebrae. And while it would periodically flair up for a week or two (or five) at a time over the next 20 years, I never came close to having surgery. The costs and potential costs just never stacked up to the potential benefits for me – especially considering the available alternatives.
Of course, that’s my experience and if you’re battling debilitating back pain, maybe surgery is the right course for you. As with anything in life though, there are costs and benefits. And while surgery may indeed be the answer in some cases, there are some drawbacks and alternatives you may wish to consider before diving in. And, of course, a reliable second opinion will always help give you the perspective and professional insight you need to make the right decision.
Five Major Types of Spinal Surgery
There are five major types of spinal surgery: spinal fusion, laminectomy, foraminotomy, discectomy, and disc replacement. Each one carries its own risks and potential benefits.
- Spinal Fusion: The surgeon permanently joins vertebrae together. The fused bones can result in reduced nerve impact but also reduce range of motion.
- Laminectomy: The surgeon removes ligaments, parts of bone, or bones spurs that may be pressing on spinal nerves. The downside is that the spine may be less stable. As a result, spinal fusion is sometimes also performed.
- Foramintomy: Similar to a laminectomy, the surgeon shaves bone at the sides of the vertebrae to widen the space for nerves exiting the spine. Much like a laminectomy, this can also cause instability and may be accompanied by spinal fusion.
- Discectomy or Microdiscectomy: The surgeon removes part (or all) of a bulging or herniated disc that may be pressing on spinal nerves. This is often accompanied by one or more of the aforementioned procedures.
- Disc Replacement: The corollary to the discectomy, in this procedure, the surgeon removes the entire disc and replaces it with an artificial version. The new disc allows continued full motion of the spine as opposed to spinal fusion.
Recovery time for these procedures can extend anywhere from three months to a full year before one can resume normal activities and there is no guarantee that future surgeries will not be required.
Alternatives to Spinal Surgery
The overwhelming majority of doctors will tell you that surgery should be a last resort. So for those whose back pain is relatively manageable, there are alternatives.
- Fitness: It sounds so simple but the act of changing one’s diet, getting a little exercise, and dropping a few pounds can make a remarkable difference when it comes to back pain – especially lower back pain caused by herniated discs. With less weigh to support there’s less pressure on the discs to push out into the nerves. Getting in shape made a significant difference for me. Until seven years ago, I drove to work every day and sat behind a desk. It was a decidedly sedentary lifestyle. It showed in my belly and I definitely felt it in my back. At some points, the pain was so bad that I had to use a cane. Then I moved to New York and worked in a more active job. The combination of less sitting and more walking was the greatest gift I could have given my spine. I still have the occasional flare up and I do have to be careful about undertaking certain activities but it’s nowhere near as bad as it was before. Of course, office jobs are extremely common and not everybody has the option (or inclination) to simply pick up and change careers. And that’s why it’s important to understand posture.
- Posture: Posture can play a major role in back health. And it’s not just how you stand and walk but also how you sit. If you’re going to be sitting for hours on end, one of the best things you can do for your back is make sure you have an ergonomically supportive chair. But that alone, isn’t enough. The act of sitting itself, no matter how comfortable the chair, will eventually shorten and tighten your hamstrings and hip-flexors. The tightened ligaments can pull on the spine, distorting its natural shape. This can become increasingly problematic as one ages and the ligaments become less flexible. If you do have to sit for extended periods, take a break every 45 minutes to an hour. Get up, walk around, and try to loosen up if you can. Also, for the guys out there, don’t sit on your wallet. It makes a difference. Seriously.
- Stretching: Simply taking the occasional break at work isn’t enough. Stretching both in the morning before work and at night after you get home can make a big difference. Before undertaking a stretching regimen, you may want to consult a doctor or physical therapist to learn proper technique. Stretching the wrong way may actually do more harm than good.
- Yoga: I’ve only tried it once in my life and I was quickly reminded why I was never much of an athlete. But my friends who do it, swear by it. While certainly worth considering, I don’t recommend trying yoga (or any other strenuous activity) while battling a flare-up. Make sure your back is in relatively decent condition and take it slow. You can always pick up the intensity down the road if you find it helpful.
- Physical Therapy: I’ve been down this road three different times when the pain was simply too much to bear and it definitely helped. The physical therapists I’ve seen not only helped relieve the immediate pain, but educated me on how my specific problem is impacting my life, and designed a daily regimen for me to help reduce the duration and intensity of future flare ups. Just be aware that a good physical therapist can be a little pricey. It was worth it for me and—if you can get insurance to cover it—all the better.
- Acupuncture: I’ve never tried it and frankly remain skeptical, but some people enthusiastically declare the wonders it does for their health. Does it actually help physiologically? Is it merely psychosomatic? At the end of the day, does it really matter as long as you’re feeling better and no actual harm is being done? If you are having difficulty finding relief via other methods, then acupuncture may be worth pursuing.
- Chiropractor: And, finally, there’s the chiropractor. I’ve been to many and I’ve always left feeling better to some degree or another… at least for a few days. If you’re dealing with debilitating back pain, I strongly recommend seeing an orthopedist first—before going down the chiropractic road. If your doctor says that trying it won’t do any additional damage, and you need immediate—albeit temporary—relief, give it a try.
Like most health issues, there is no one-size-fits-all formula here. Everybody is different with different bodies, different ages, different ailments, different lifestyles, different budgets, and different responsibilities. They key is to find what works for you.
Before you do anything, be sure to consult a physician and ask questions. Then seek out another physician to get a second opinion that ensures you’re exploring all of your options and only undergoing surgery if and when it’s truly necessary.
There’s no shame in asking questions—lots of questions! And it certainly can’t be any more shameful than getting helped off the dance floor by the future husband of your high school crush.
Although it may not be the first thing that comes to mind, your diet can influence the health of your back.
A balanced diet including the proper amount of vitamins, minerals, and nutrients helps support the musculoskeletal system, build strong muscle and bone, and reduce the incidence of back problems. In addition, weight loss, daily exercise, and smoking cessation can optimize spinal health, as well as your overall health.
Spine-health.com has done a great job giving an overview of how your food intake influences your spinal health. They clearly outline the benefits of the common vitamins we seek to include in our daily diet.
In particular, I recommend paying attention to calcium which is essential for bone health and minimizing the complications of osteoporosis. Vitamin D also improves calcium resorption so spend a bit of time in natural sunlight. And don’t forget super foods such as spinach, kale, and broccoli which include large amounts of vitamin B12, iron, magnesium, and calcium.
After all, the best medicine is preventive medicine!
On January 30th, 2015, Tiger Woods shot his worst professional round ever and missed the cut at the Phoenix Open.
The once dominant golfer who won the 2013 PGA Player of the Year is ten months removed from a lumbar microdiscectomy. And on that late January Friday, he appeared decidedly mortal.
Two days later, on February 1st, 2015, Patriots tight end Rob Gronkowski caught 6 passes for 68 yards and a touchdown to help his team win Super Bowl XLIX. Nineteen months earlier, he underwent a lumbar microdiscectomy to relieve pressure from a herniated disc. He was back on the field within four months and led all tight ends in receiving last year (despite missing training camp while recovering from a torn ACL).
Two world class athletes, two very different stories.
A discectomy is traditionally the option of last resort for herniated disc sufferers. In this procedure, surgeons remove the herniated part of the disc to relieve pressure on the nearby nerve. The microdiscectomy version, chosen by both Woods and Gronkowski, is performed with an endoscope thus allowing smaller incisions, less muscle retraction and generally minimizing trauma to surrounding tissue.
Gronkowski’s 2013 procedure was actually his second microdiscectomy. At 25 years old, he is in fantastic shape and has shown a remarkable ability to quickly recover from numerous injuries. Most people considering back surgery however, are older, and it’s safe to say that most of us aren’t genetic marvels like Gronkowski. Woods is 39 years old and despite being physically fit, his recovery has been markedly slower with many beginning to wonder if the years and injuries have finally taken their toll on his career.
Like any surgery, especially spine-related, microdiscectomy comes with risks and there are no guarantees of success. In addition to potential complications from anesthesia, microdiscectomy procedures can result in dural tears (cerebrospinal fluid leak), nerve damage, and infection. Additionally, 5%-10% of patients develop a recurrent disc herniation at some point in the future.
From 2000-2004, a randomized clinical trial called the Spine Patient Outcome Research Trial (SPORT) was conducted using 501 lumbar herniated disc patients over 13 multidisciplinary spine clinics in 11 U.S. states. Half were randomly assigned surgery while the other half were assigned therapy. In both the surgical and non-surgical cases, patients generally reported more relief from radiating leg pain than from lower back pain itself. And while the surgical patients were discovered to exhibit marginal improvement over the non-surgical patients for the first and second years after the study, those differences decreased as time went on with some patients requiring additional surgery.
For patients without insurance, physical therapy can cost anywhere from $50 to $300 per treatment session. Microdiscectomy, on the other hand, can cost anywhere from $15,000 to $100,000. Costs for patients with insurance will vary depending upon coverage, of course.
None of this is meant to imply that non-surgical treatment is always preferable to a microdiscectomy. In fact, microdiscectomies are fairly common and, usually for good reason: many patients will benefit from the surgery in a way that they simply would not benefit from alternative treatments.
Surgery should never be undertaken lightly. And a second opinion ensures you receive the right surgery for your condition and unique circumstances.
Rather, the point is that the decision to undergo surgery should never be taken lightly. Multiple factors should be considered including the financial cost, time, risk, rate of recurrence and—most importantly—your own unique conditions.
Gronkowski and Woods are two different men who underwent similar procedures with different results. In both cases, we would expect that they received multiple opinions, top notch care and that—ultimately—the surgeries they underwent were likely the appropriate ones for their circumstances.
We all have differences – age, job, sex, health, recreational activities, injury history, pain tolerance, etc. Each patient and their circumstances are unique and should be thoroughly reviewed before a treatment is decided upon.
Before deciding on your course of action—particularly one that involves surgery—it’s always best to consult a physician and to get a second opinion.
Whenever you’re considering spinal surgery, getting a second opinion is essential. It’s the best way to ensure your surgery is, in fact, the right surgery for your condition and the least invasive option.
Here’s what distinguishes Second Opinion Spine from your other options.
Five Reasons to Get a Consultation with Second Opinion Spine
- Unlike many websites offering second opinions, Second Opinion Spine is one of the few sites that is NOT looking to have you travel to our office, or to convince you to have your surgery with us. To the contrary, we believe that by remaining purely consultative, we can remain entirely objective in our recommendations. In essence, offering you an opinion that we would offer to a family member.
- Second Opinion Spine is the ONLY second opinion site that provides the opportunity for a direct conversation with our consulting spine surgeon. Such one-on-one conversations welcome dialogue, provide us with more personal insight into your medical condition, how your particular spinal condition is affecting you, and your goals seen in terms of operative or non-operative outcome. Our personal conversation with you allows the opportunity for your related questions to be answered more thoroughly.
- We understand the value of your time. A virtual second opinion from Second Opinion Spine provides the opportunity to avoid taking valuable time off from work. Virtual consultation means that you no longer need to travel to a major academic center–or to an entirely different geographical region–in order to obtain a high quality surgical opinion from a recognized expert in the field of spine surgery. Spending hours waiting in a physician’s office filling out duplicative medical history and insurance forms becomes obsolete. A virtual second opinion provides the opportunity to schedule your personal conversation with our spine surgeon at a mutually convenient time that fits within your schedule, regardless of where you may live.
- We provide rapid responses with our virtual consultation. We understand that some patients already have surgery scheduled and are seeking a second opinion for peace of mind and reassurance that the procedure that has been offered is appropriate and as least invasive as possible. Our consults can be provided within 48 hours of receipt of your imaging data.
- With the advent of electronic medical records (EMR) and health information exchanges (HIE), your medical information personal data may be legitimately shared with more physicians, insurance companies, and even government agencies (including Medicare and Medicaid) than you may be aware of. Your conversation with our spine surgeon remains entirely private and confidential.
Whether you decide to work with us or not, we strongly recommend getting a second opinion from a reliable provider. It’s one of the best choices you can make to ensure that your original diagnosis is the right one.
If you would like to contact us, please fill out the form on the right side of this page or call us directly at: 855-377-4767
Spinal surgery is intimidating under the best of circumstances. When you are in pain and know that your back is not functioning properly, you need to spend the time necessary to gather all of the facts regarding your particular condition, and make sure that you understand the implications of any proposed surgical procedure. Understanding the risks of your surgery and determining whether or not your particular spine procedure might result in additional pain or give rise to a cascade of subsequent surgical procedures is part of your due diligence.
As with any type of surgery, there are inherent risks. As such, your spine surgeon should present to you all conservative options available to treat your condition, and he or she should offer you the most minimally invasive procedure possible to achieve success with your particular condition. Unfortunately, there are situations where no minimally invasive options are appropriate, and you need to be mentally and emotionally prepared to undergo a lengthy and difficult procedure with a long rehabilitation period to follow. Understanding the true nature of your anticipated rehabilitation, and adjusting your expectations accordingly, is critical to the long term success of your procedure. An objective second opinion can help confirm that the most efficient procedure associated with the best long term outcome has been offered to you. Such a second opinion can also be used to help you to mentally prepare for the appropriate course of rehabilitation as seen through the eyes of an independent spine surgeon. If you are unsure of how to proceed, please read this article on how to get a second opinion for spinal surgery.
Is Spinal Surgery Dangerous?
As suggested, there are risks associated with any surgical procedure. It is up to you and your physician to discuss what the acceptable level of risk is for your unique situation. Risks of spinal surgery to be reviewed with your surgeon might include the risk of infection, permanent nerve or spinal cord injury, non-healing of a fusion (pseudarthosis), development of chronic back or neck pain, adjacent level decompensation and the need for subsequent surgery.
As with most surgical procedures, steps can be taken to minimize these risk to you–the patient–so that your recovery is as quick as possible and your overall health and functionality is improved.
Can a Second Opinion Reduce My Spinal Surgery Risks?
Simply put, getting a second opinion from a qualified spine surgeon helps to reduce the overall risk of your procedure. When you permit another surgeon to review your history and imaging data, you gain access to the experience and knowledge of an independent and objective expert in the field of spine surgery who is incentivized only to look out for your best interest.
Our spine surgeons have undergone extensive training at some of the most respected academic medical institutions in the country which may allow for unusual insight into your diagnosis. A personal discussion with one of our surgeons can provide an opportunity for you to consider alternative, and possibly less invasive, solutions for your condition. In summary, our spine surgeons may identify opportunities that your original surgeon overlooked or was unaware of.
Even if our second opinion doesn’t identify a less invasive solution for you, it will provide you with the peace of mind that your surgeon’s recommendations provided the most appropriate treatment for your particular spinal condition.
Are you ready for a spinal surgery consultation? We welcome the opportunity to work with you. Simply call us at 855-377-4767 or visit the site to start the second opinion process.
Check out this link to a fascinating, but concerning, article published by CBS News highlighting the significant variation that exists in the rates with which spinal fusion is offered to patients across the country.
In this article, CBS News publishes an online database revealing the number of spine fusions each doctor in the U.S. billed Medicare over a two year period. The data shows that some spine surgeons perform fusion procedures far more frequently than their peers emphasizing the need to obtain a second opinion if you are offered this type of surgery.
From 2001 to 2011, the number of spinal fusions in U.S. hospitals increased 70 percent, making them more frequently performed than even hip replacements.
Use this link to search your surgeon’s percentage of patients seen who received a spinal fusion, along with an explanation of how this data is to be interpreted.
Many people don’t know how to go about asking for, or getting, a second opinion on their spinal surgery–or, for that matter, many other important medical procedures.
If you find yourself in this group, don’t worry. We’re here to help! One of the questions we hear most frequently is…
Is it rude to ask for a second opinion on spinal surgery?
Absolutely not! Your good health and well-being are incredibly important and there is nothing wrong with asking for a second opinion.
Think about other big decisions in your life. Before buying a home, you speak to a number of trained professionals who help you understand which options are the best for you. Similarly, if your car needs work, you seek out more than one quote–not just to get the best price, but also to get peace of mind that both mechanics are identifying the same issue and recommending similar repairs. You should give your body the same consideration.
Of course, it’s polite of you to consider your doctor’s feelings, but rest assured: they will not be offended. Far from it! Your doctor is a professional. As such, he or she has your best interest at heart, will welcome anything that puts your mind at ease, and will appreciate the insights provided by a reputable spinal surgery second opinion.
And, remember: your spinal surgery is up to you. Your doctor should help guide you to the right choice for your situation, but the final decision is yours. As such, you should do everything in your power to make the choice clearer and to give yourself peace of mind.
How do I tell my doctor I want a second opinion
(or that I’ve already gotten one)?
Be forthright. You have a right to be involved in the process–it’s your spinal health that’s at stake!
Explain to your doctor that you want more information and would welcome a second opinion to ensure all options have been explored and that the best possible treatment path for your spinal surgery is chosen.
If your doctor appears angry or upset at your request for a second opinion, you should seriously consider looking elsewhere for your spinal care needs. Even if you remain with your doctor, keep in mind that you don’t need to rely on them for a referral. You can find expertly trained spinal surgeons online who will be happy to give you a reliable second opinion at a reasonable cost.
Remember, you get second opinions for all types of situations in your day to day life–don’t feel bad about asking for one when it comes to something as serious as spinal surgery.
Although second opinions are a very wise idea in spinal surgery, one instance when a second opinion does not make sense is in the case of a true surgical emergency known as cauda equina syndrome.
Although rare, very large herniated discs can cause this syndrome which is a combination of loss of bowel/bladder function, saddle anesthesia, and usually pain/weakness in the lower extremities.
Patients with a true cauda equina syndrome typically need urgent surgery to help reduce the risks for long-term problems, such as bowel, bladder, and/or sexual dysfunction, and/or paralysis
This article on Spine Universe effectively describes this condition in greater detail.
Although spinal fusion surgery often immensely improves a patient’s quality of life, it’s also a big surgery with a long recovery and should be undertaken only after less intense options have been exhausted. For example, the same benefit can sometimes be achieved with a decompression procedure without the need to fuse.
Unfortunately, some surgeons are driven by financial incentives offered with the fusion procedure, causing them to recommend it more frequently than it’s truly needed. By getting a second opinion before your spinal fusion, you’ll ensure you don’t undergo surgery you don’t truly need.
“Physicians already have an incentive to do surgery — Medicare and insurers pay them for each surgery they do,” he said. “We trust doctors to use their judgment. The question is: Does this particular type of business heighten the incentive to move an otherwise honest doctor in the direction of unnecessary surgery? The report suggests that it doesn’t.”
Take the time and read this article posted last week in The Washington Post. Let us know your thoughts…