Spine Surgery Is Damage to Accomplish a Goal
POSTED ON IN Spine BY Chris Centeno
I spoke to two patients yesterday who are backed into a corner by their neck pain. One has already pulled the trigger on an invasive fusion, and the other was offered a big surgery, but due to her extensive healthcare experience decided to "just say no." For both of them, the thing that sticks in my mind is that spine surgery is damage to accomplish a goal; the only question is, how much damage? The problem is that most patients don't view it this way. Instead, they view it as a "fix." Let me explain.
My Patient Who Pulled the Trigger
The first patient is a very active older woman who noted pain after a very strenuous workout. She had a bevy of conservative care and then finally some injections, but wasn't helped. She never did get to the types of injection procedures that likely would have helped, so she ended up with a screw that traverses each C1–C2 facet joint and traded one problem (pain from that joint) for another (pain above that joint, now at C0–C1). She's miserable, and the surgeon now believes that the screws are coming loose, so she may well need a second surgery. She has adjacent segment disease, or ASD, which I describe in detail below (the video is about the low back, but the same issue happens in the neck):
The Other Patient Who Blinked
The other woman is younger and had been a healthcare consultant. She merely has a disc bulge irritating a nerve. However, she's in an immense amount of pain, so one surgeon has offered her a three-level disc replacement. This is bizarre, as only one disc has slightly degenerated (the one with the bulge). She was savvy enough to say "no way." Once I examined her yesterday and reviewed her MRI, I was floored that she was offered this surgery. However, she finds herself backed into a corner, having tried a traditional steroid epidural and gotten only temporary relief.
Surgery Is Damage to Accomplish a Goal
By the end of the day, I was frustrated. Here I had two patients; one had already fallen victim to overly invasive surgery, and a second was holding off. It was then that I told the second patient that surgery was damage to accomplish a goal. The only question was, how much damage? In her case, the surgeon was proposing almost maximum damage. The worst thing she could have done was to have three levels in her neck fused. The second worse thing was having three levels replaced with artificial discs. Why? She only had one slightly degenerated disc with a bulge. The other two looked much better than any disc in my neck. So the discs in her neck already worked better than any artificial disc they could install. For this patient, I'll use our latest generation platelet lysate injected precisely around that irritated nerve, and given our past results, there's about an 80% chance I can help her avoid this ridiculous surgery. Even if she falls into the 20%, she knows that she needs to minimize surgical damage by going with the smallest procedure that will get the job done. In her case, a muscle-sparing microdiscectomy. There are really only a handful of physicians who can pull that procedure off, so that's where she would go if needed.
Everyone Wants a Quick Fix
The issue is that most patients believe that spine surgery is a "fix," or curative. Nothing could be further from the truth. In fact, it's always some form of damage. There is no "curative" procedure that restores the spine like it was before anything happened. While precise regenerative-medicine injections using platelets and stem cells may be able to do something akin to spinal restoration in the right circumstances and in the right patients, even those procedures rarely restore the spine to perfect working condition. They can, however, minimize the damage done during the procedure and maximize the results. The upshot? Please don't be fooled by the promise of the surgical quick fix. It doesn't exist in the spine, and it's unlikely to exist for decades to come. So the best you can do is to minimize the damage and maximize the result.
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