“By failing to prepare, you are preparing to fail.”
– Benjamin Franklin

Considering Spine Surgery?


To many people with poorly controlled neck or back pain, the idea of surgery may offer a strong appeal. However, due to the high incidence of undesirable outcomes for spine surgery, estimated to be up to 40% for lumbar surgeries, a degree of caution is advised regarding when to consider surgery and how to assess the process.


One of the major problems in assessing the likelihood of benefit from surgery is the lack of good information and research to guide decision making. The field of medicine progresses at a rapid rate with contiuous development of new procedures allowing for little time to look back and gather data to assess effectiveness.


All that being said, how does one approach the consideration of spinal surgery?


What follows is an attempt to guide a patient in the process of considering neck or back surgery for spine-related conditions. Due to the obvious fact that everyone has different needs, expectations, medical conditions and potential for complications as well as different surgeons offering different techniques at different medical institutions it makes individualized advice impossible.


What follows are some basic considerations to keep in mind.



Coordinating Post-Operative Pain Management with the Surgeon or Dentist

Surgical Pain – Post-Operative


See Also:

Low Back Pain (LBP) – Overview

LBP – Disc Pain

LBP – Facet Pain

LBP – Myofascial Pain

LBP – Sacroiliac (SI) Joint Pain

LBP – Sciatica

LBP – Spinal Stenosis

LBP: Failed Back Surgery


Treatment Procedures:

Epidural Injections

Facet Joint Injections and Nerve Procedures

Heat & Cold Therapy

Inversion Therapy

Massage Therapy

Physical Therapy

Trigger Point Therapy



Considering Spine Surgery?

Here are some thoughts and suggestions for those considering neck or back surgery, although they may apply for any surgery. When a time approaches when one is considering surgery for a painful condition, please consult with your pain physician. Also, when considering low back surgery, please learn about Failed Back Surgery.

See Failed Back Surgery


Rule #1: Do not base your decision on someone else’s experience


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



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




Spine Surgery Overviews

  1.  2016 NIA clinical guidelines

LBP Failed Back Surgery Syndrome (FBSS)

  1. Failed back surgery syndrome – current perspectives – 2016



Emphasis on Education


Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.


For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.


Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.</ span>


For more information, please contact Accurate Clinic.


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