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Back Surgery: A Patient’s Perspective

Back Surgery: A Patient’s Perspective

“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.

 

 

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A Healthy Diet Equals a Healthy Back

A Healthy Diet Equals a Healthy Back

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!

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Wellness Benefits: What Patients Need to Know

Wellness Benefits: What Patients Need to Know

For those of you in the corporate work force—or for those of you who keep track of the changing trends in the healthcare—you may have heard about wellness benefits and wellness management companies.

What are wellness benefits and the companies that manage them?

Let us explain!  Wellness benefits are employer-sponsored benefits provided to employees as a preventative measure to improve and maintain the general health of employees.

Many large companies are now teaming up with wellness or surgery benefits management programs to help give their plan members access to the tools and resources they need to make the most informed decision when considering an elective surgery.

Companies are looking to these wellness management partners to improve healthcare quality and results for their members while also keeping the overall program costs contained.

The employee avoids unnecessary surgery.
The employer reduces their costs.
It’s a win win.

To put that in real-life terms, let’s take a look at an example: an employee who is considering spinal fusion surgery. One of the wellness benefits the employee may receive is the option to get a second opinion before undergoing surgery. Since nearly 30% of all spinal surgeries are deemed medically unnecessary, there’s a size-able chance that the employee will learn that they don’t, in fact, need the surgery and that less invasive option may alleviate their condition.

As a result of these wellness benefits, the employee avoids unnecessary surgery. And the employer has reduced their costs. It’s a win win.

This model makes sense for everyone involved and is the likely future of healthcare insurance.

Before we sign off on this post, I’ll address one question you may still have:

Why would a surgeon recommend surgery that’s unnecessary?

Sadly, it could be for their own potential gain.  If they perform the surgery, they will receive greater compensation. A second opinion ensures there is no such bias—which is the very reason we started Second Opinion Spine.

Of course, the initial recommendation may also be well intentioned, but misguided. If a surgeon is familiar with one, specific type of surgery, they may be quick to recommend it and, subsequently, overlook other—less invasive—options.

If you are considering spinal surgery…

If you or a loved one are considering spinal surgery, please contact Second Opinion Spine today.  Simply fill out the form on the right side of this page or call us at 855-377-4767.

Even if your company doesn’t provide wellness benefits, we strive to keep our costs affordable so you can receive quality advice and peace of mind.

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The Most Dangerous Sports for Your Spine

The Most Dangerous Sports for Your Spine

With Super Bowl Sunday coming up this weekend, an awful lot of us are thinking about football.

While our thoughts this weekend will likely focus on the fun, the competition, the nachos… there are also serious questions about the impact football has on the body and—specifically—the spinal cord.

As an an orthopedic spine surgeon, I thought I’d address a question I am often asked by patients, friends and family:

What sports are the most dangerous sports for your spinal cord?

After having researched this quite a bit, my personal list, in no particular order, is below. And, yes, you’ll see that football is, in fact, on it:

  • Ice hockey
  • Football
  • Lacrosse
  • Wrestling
  • Rugby
  • Horseback riding
  • Rodeo sports
  • Gymnastics
  • Cycling
  • Moped/ATV sports
  • Cheerleeding

While I did say that list was in no particular order, I will note that rugby may well deserve to be at the top of the list. Literature from the United Kingdom (where rugby is highly popular) suggests that the sport might be the most dangerous of all sports given the lack of protective equipment and the “scrum” where players aggressively push against each other in an attempt to get the ball.

Keep in mind, of course, that exercising is a great way to strengthen your core muscles and keep your spine healthy–particularly back exercises. While some sports present risk to your spinal cord, that risk should not be a deterrent from leading a healthy and active lifestyle.

If you incur an spinal injury due to any of these sports–or otherwise–you are always welcome to reach out to Second Opinion Spine for a reliable, affordable second opinion.

Stay safe and enjoy the Super Bowl!

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Obamacare Presents Physicians with Ethical Dilemmas

Obamacare Presents Physicians with Ethical Dilemmas

As we enter the year 2015, more and more patients are enrolling in “healthcare exchange programs”, also known as Obamacare.

As this takes please, patients need to recognize the impact this may have on physicians and their decision-making process. This article from Forbes nicely highlights some of the ethical dilemmas physicians face practicing in this new healthcare environment and what patients can do to protect themselves.

What this article doesn’t mention is that physicians are now being reimbursed less for surgical procedures which incentives them to offer patients more surgery.

In addition, patients are limited in their ability to see physicians outside of their specific network and are sometimes “pigeon-holed” into seeing only one provider–and subsequently only receiving one point of view about their health needs.

As a result, a second opinion for spinal surgery is not only important but prudent–now more than ever.

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When Should I Ask for a Spinal Surgery Second Opinion?

When Should I Ask for a Spinal Surgery Second Opinion?

If you’ve recently been given a medical diagnosis that includes the possibility of spinal surgery, you probably have a lot of questions and are wondering if, in fact, you need the recommended surgery.

You may also be wondering if you should seek out a second opinion.  This is completely normal–most people want to make sure that they, and their medical providers, are making the correct choice when it comes to any major surgery.

Even though second opinions can give you peace of mind, many patients still wonder when–or if–they should pursue one.

Reasons to Seek Out a Second Opinion

Simply put, we believe a second opinion is in order any time serious surgery has been recommended to you–whether it’s for your spine or any other part of your body.  Your health is too important and unnecessary surgeries are recommended far too often.

Having said that, there are certain instances when it is particularly important to seek out a second opinion.  Here are a few:

  • You are uncomfortable with your primary doctor for any reason. In this case, you should not only seek out a reliable second opinion–you should also consider transitioning to another provider, if possible.
  • Your primary doctor has not fully explained to you why the surgery is necessary.  Sometimes doctors rush through complicated explanations before a patient can fully comprehend the implications.  Or, even worse, they recommend a surgery because it’s a preferable option for them–not you!  We take the time to discuss your options with you and ensure you understand them before making your final decision.
  • You are told that spinal surgery is the only option.  While this may truly be the case, you do not want to proceed with surgery until you’ve exhausted every other non-surgical option.  Our surgeons are experts in the field of spinal health and will help you explore all of your options.
  • You have undergone spinal surgery in the past.  Additional surgery can mean additional complications.  All the more reason to get another set of well-trained eyes to review your case.
  • You love your doctor, but just want some additional peace of mind.  Even the best medical providers can overlook or be unfamiliar with certain solutions.  Getting a second opinion isn’t a reflection on your faith in your primary doctor, it’s a way to give them–and you–additional insight into your condition.

When to Ask for a Second Opinion

If possible, once you’ve received your initial diagnosis, take a couple of days to let it sink in and do some additional research on your condition and the recommended procedure.

Once you’ve done that–seek out a second opinion.  By taking action quickly, you are ensuring that all parties involved–you, your family and your primary medical provider–have enough time to review your unique requirements and can offer you the best counsel.

We Are Here to Help

Helping people is why we became surgeons in the first place and we’d be happy to help you with your second opinion as well.

Call us today at 855-377-4767.

You can also enter your contact information in the form on the right side of this page.  One of our case coordinators will contact you to get some initial information, answer your questions and schedule a consultation with one of our surgeons.

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What Are The Chances That Spine Surgery Can Cause More Injury To My Back?

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 achieveu.s. news top doctor award image 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.

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Spinal fusions on the rise

Spinal fusions on the rise

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.

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How to Get a Second Opinion for Spinal Surgery

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 secondstethoscope 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.

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Cauda Equina Syndrome (CES)

Cauda Equina Syndrome (CES)

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.

 

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