Archive for January, 2010

In my practice, I always look to avoid surgery unless there are neurological changes such as weakness and pain that affects reflexes or function. I saw a patient yesterday with only neck pain scheduled for neck surgery without any attempt at pain management. I always try a series of injection, medication, and therapy first and surgery as a last resort. I also want patients to understand all their options by using Internet sites like We even have added acupuncture as an option. The goal is to use all reasonable modalities prior to offering sugery and to also let patients review their options. New technology can also make a tremendous difference in successs and outcomes.

Many patients come to me only to ask for minimally invasive procedures. I can assure you that most spinal problems other then a simple disc herneations will be needing the addition of stabilization if there is severe changes on MRI. Certainly, I prefer smaller incisions and fast recoveries but the focus must be on proven results! I believe strongly on a new breed of implants called interspinous process devices that have worked out well.

Most surgeries now are extremely well trained and make small incision and manytimes in outpatient setting.These surgeries still should be a last resort after injection and therapy. Most disc ruptures occur at lower two spinal levels. We tend to fuse only when there are reccurrent surgeries or structural bony weakness.I do not put patients on chronic narcotics as this was a primary reason for the surgery to decrease pain.

Patient need to know this term should not be confused with good outcomes. Most spinal problems other then simple disc surgery require very thought surgical techniques . Manytimes, an incision will be more extensive as multiple problems including removal of compression spinal cord and insertion of stabilizing devices.Do not be fooled by issues that are cosmetic rather then proven peer- reviewed results.Look for articles published about claims of laser as well as other products such as distraction tables.Spine surgery should always be a last resort for most patients. Stem cell research is going on but not yet effective for most patients. A team aproach with neurologist and therapist helping the spinal surgeon real can be rewarding.

Most patients need to understand that spinal stenosis is a natural aging process not really rare or unexpected to occur as we all get older. The real issue is when this condition causes symptoms that change your quality of life. This maybe leg or buttock pain or weakness as regular examples. Fortunately, very few patients need surgery! Usually, a minor injection under fluro and therapy will substantially alleviate symptoms. Yes the problem is still there but quality of active life returns quickly. Dr Geisse and myself working as a team have lowered the need for surgery to 5 percents as most patients are functioning well with very little medication. Look at the videos on this site for more details.

Patients need to have a real understanding of results ! I see so many failures of these techniques.The patients should be shown published outcomes.

So few patient need surgery and need to be walked thru a team approach of pain control and prevention. Dr Geisse and myself work together in this combined way. I see a lot of non-validated claims showing no peer-reviewed data that should be a red flag. Look for published works by centers that make claims using new techniques such as stretching tables or laser. We all want the very best results that have real proven outcomes.Even the best doctors report 80 percent success for surgery never perfect. However, this can mean a real improvement in quality of life for most patients.

Increase exercise and healthy diet to start New Year! The spine is waiting your spirit of good health. So much of the pain I treat could be prevented just by applying basic prevention to one’s lifestyle.