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Tiger Woods Misses the Cut. Was Back Surgery the Right Choice?

Tiger Woods Misses the Cut. Was Back Surgery the Right Choice?

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.

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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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5 Reasons to Get a Second Opinion on Spinal Surgery Now

5 Reasons to Get a Second Opinion on Spinal Surgery Now

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

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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

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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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Procedural outcomes being tracked

Procedural outcomes being tracked

Cervical spondylotic myelopathy (CSM) is one of the more common reasons patients need to undergo surgery for their cervical spine. In this instance it’s not usually a question of whether or not you need surgery, but rather what’s the best surgery for you. Here second opinions can be invaluable.

Though precise figures are hard to come by, Dr. Ghogawala estimates the number of CSM surgeries has nearly doubled over the past decade or so to 200,000 a year, with some $4 billion a year in hospital charges alone.

Check out this brand-new article in the Wall Street Journal describing the current debate in spine surgery as to what will be the optimal surgical outcome for each individual patient with CSM.

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