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Lower back MRI scan with gloved physician's hand & pencil

On an average day as a spine surgeon, I often encounter patients who will tell me the last thing they want to have is spine surgery.

I am often bemused by this, since they are telling that to a spine surgeon. But at the same time, I understand completely what they mean and why they are saying that.

The specialty of spine surgery in its current form is a relatively new specialty when compared to other medical specialties such as internal medicine, general surgery and even heart surgery.

As such, the specialty is still in its “learning” phase with new procedures and techniques being developed each day. Spine surgery has recently benefited from new imaging techniques such as CT scanning and MRI scanning. These two technologies have taken much of the guess work out of being able to diagnosis what is wrong with a patient’s spine and what treatment to recommend.

Before the 1990s, spine surgeons really had only their diagnostic skills, regular X-rays and CT scans to diagnose and recommend treatment to patients with spinal aliments. X-rays and CT scans are by no means primitive tools, but when compared to the more modern MRI they are definitely lacking in the ability to precisely “look” into the body and clearly see what is wrong with the spine.

The advent of and regular availability of MRI plus the continued improvement of MRI imaging has been a godsend for spine surgeons and their patients. We can now precisely diagnose which disc is herniated, how big the herniation is, which nerve is being pinched and where. We no longer are guessing as to which disc has “slipped.”

All this new information has led to more precise surgical treatments and has taken out the guess work and former exploratory nature of early spine surgery.

With the advent of better imaging has come better understanding of spinal anatomy and how the spine functions, leading to the additional benefit of more precise and targeted surgery.

The most recent development of minimally invasive spine surgery, or, MISS, now has allowed surgeons to perform corrective spine surgery through smaller and smaller incisions which, in turn, has led to quicker surgeries and quicker recovery.

In fact, spine surgical techniques have advanced to the point where more and more spine surgeries now can be performed in an outpatient setting with patients being able to go home the day of surgery. I have implemented this development, Outpatient Spine Surgery, or, OPSS, as well as MISS to the benefit of my patients.

So, if with all these new modern imaging and more precise surgical techniques, why does spine surgery still have such a bad reputation with some patients?

Some of this bad reputation is historical in that patients can recount stories told to them by friends and neighbors of friends and neighbors who have had bad experiences and outcome from spine surgeries.

There is no doubt that some of these stories are true, and it will take time of patients telling new stories of the benefits of current spine surgeries to overcome these older tales.

Another factor is that there has been an increase of spine surgeries being performed by surgeons who are not well trained. Naturally, these surgeons do not have good outcomes for their patients, leading to more stories of bad spine surgical outcomes.

A third and equally important factor is the aggressiveness of some spine surgeons to operate too quickly and not to allow other nonsurgical treatment options to work.

Most patients with a bad back/back pain should exhaust nonsurgical treatments such as chiropractive care, medications, physical therapy, and acupuncture before rushing to surgery.

These nonsurgical treatments have been proven to be very effective in treating most patients with a bad back/back pain. In fairness, most patients with back pain/ a bad back are much better off trying these nonsurgical routes before surgery.

Spine surgery, therefore, should not be the first line of treatment for most patients but should be reserved for those patients who have tried and failed nonsurgical treatments.

Dr. Dwight S. Tyndall, FAAOS, is an outpatient spine surgeon practicing in the Region. His column, which appears every other week, covers a wide range of health and medical issues.

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