Accurate Education – Considering Spine Surgery?

Your successful outcome is completely unrelated to someone else’s outcome, good or bad. The reasons for this are obvious, but are related to the likelihood of different diagnoses, different surgeons with different levels of experience and expertise providing different techniques and different preoperative and postoperative risks for bad outcomes.

Rule #2: Be clear on your reasons and expectations for having surgery

There are three basic reasons to consider surgery:

1- Relieve pain

2- Improve impaired nerve function

3- Preserve or protect spinal cord function

1. Relieve Pain

The most common reason for considering surgery is to relieve pain but often the weakest argument. There is never a guarantee surgery will relieve pain and it may make it worse. Most of the time pain can be controlled adquately with reasonable alternatives to surgery. Surgery for pain control should rarely be considered until all more conservative, less risky treatments options have failed. Such options might include physical therapy and myofascial treatment, a course of medications and a reasonable period of time to assess a natural course of resolution.

Another important factor when considering surgery for pain control is that in many circumstances there is more than one pain generator contributing to the chronic pain syndrome. Failure to identify an accurate diagnosis for a significant source of pain will result in failure to relieve that pain, and worse, potentially seek a surgical answer when there isn’t one. It has been well established that an abnormality on an MRI or other imaging does not necessarily correlate as the source of pain. Myofascial pain is not identified with MRI or other imaging studies and is frequently overlooked and underdiagnosed. Because the location, character and pattern of pain associated with myofascial sources often mimics and coexists with other sources of pain, it is a significant source of failed response to surgery and interventional procedures.

2. Improve impaired nerve function

When a nerve root exiting the spine is compressed by a herniated dise, bone spur or facet arthritis the result may be numbness and/or weakness in the affected limb causing impaired function and interference with quality of life. While in some circumstances time, physical therapy and/or exercise can improve or reverse these impairments, medication management is not going to offer much benefit. Therefore surgery may be the best viable option. However, before seeking a surgical solution consider that the longer the impairment has been present, the less likelihood of successful return of function. This should be discussed carefully with the surgeon prior to surgery to identify a reasonable prognosis for success.

3- Preserve or protect spinal cord function

When a herniated dise, bone spur and/or facet arthritis compresses the spinal cord, the potential for significant functional impairment exists, including paralysis. Even in the absence of current dysfunction, the potential is significant for subsequent spinal cord injury in the event of trauma as might occur in a motor vehicle accident. This is often a strong argument for surgery and one that is unlikely to respond to physical therapy or medication treatment. A clear and focused discussion with the surgeon regarding the risks of complications with the surgery should be engaged.

Rule #3: Do your homework and learn about your condition

In order to communicate effectively with your surgeon, you must understand your condition thoroughly. You should be educated about the surgical options available to be prepared to discuss them. The more you know the better you will be able to make a well-informed decision. Remember, this decision may be one of the most important decisions in your life.

Rule #4: Do your homework in selecting a surgeon

It is difficult to select a surgeon. Insurance options may be limiting. But in the end it is up to you. Get more than one opinion from other physicians as to who to consult. When you engage the surgeon in consultation regarding his recommendations for surgery, do not be afraid to ask anything pertinent to your decision making. While we hope for more, the surgeon is ultimately a technician performing a procedure and you should be prepared to ask about his experience performing this procedure on patients with conditions similar to yours. What does the surgeon define as “success” for your procedure? How does his success match yours?

In some cases your surgeon may not have the personality or bedside manner you w
ould prefer. Is this important? Does he take the time to provide the education you need? Will the surgeon and/or the staff be available after the surgery to assist you in the recovery process?

Rule #5: Prepare for surgery

Because not all surgery is successful in providing the outcome expected, it is important to understand what factors contribute to “failed” surgery and what can be done to reduce risk for sub-optimal outcomes. This topic is explored in Failed Back Surgery Syndrome (FBSS).

Mental Preparation

Clearly one should enter surgery in their best health possible to achieve the best outcome possible. This includes both mental and physical aspects. If one is significantly depressed or otherwise psychologically  impaired, this should be treated and improved before surgery. Using one’s mind to achieve a positive mindset before surgery can be very rewarding – working with a counselor or medical hypnotist to learn positive though processing techniques to facilitate a better outcome can be effective.

See Using the Mind

Nutritional Preparation

Preparing for surgery from a nutritional perspective is also important. Dietary considerations are important and should be discussed with the dietitian, for both pre- and post-surgery. Surgery impacts the body with a great deal of oxidative stress that would likely benefit from foods high in antioxidants or the use of supplements helpful for oxidative stress.

See NRF2 Activators

Quit Smoking

Smoking has been well established as a factor contributing to increased complications from surgery. Some surgeons actually delay surgery until it is proven with drug screens that the patient has discontinued smoking. The longer the “smoking-free” time before the surgery, the greater expectation of benefit.

See Smoking Cessation

Obesity

Like smoking, obesity has been clearly identified as a factor that contributes to more complications for surgery. While weight loss requires time, the process to lose weight should be engaged as soon as the consideration for surgery arises.

See Weight Loss

Rule #6: Take Steps – before surgery – to Reduce Post-Op Pain

There are things that can be done to both reduce the amount of pain experienced in the immediate days and weeks following surgery as well as reduce the risk of post-op pain becoming chronic.

See: Surgical Pain – Post-Op