“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.
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.
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.
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