Good Morning Spine

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I often reflect on how difficult it must be for a patient to choose a spinal surgeon. Even more challenging, whether to trust a surgeon for the necessity of surgery. Very scary to be the patient with pain and not knowing what to do. I try to give options and ask patients to sleep on it. Only recommend surgery as emergency for very special clinical situations. I want them to know the fit between surgeon and patient’s trust must be mutual for surgery to proceed. I started giving patients’s my cell and home number ten years ago to increase my own person belief that surgery was a reasonable option. Obviously, this access exposes me and my whole personal world should results be less then expected. I thought about stopping this added stress as so many physicians thought this was “insane” to give home phone knowing spinal surgery patients have upwards 20 percent unhappy with their outcomes. Fortunately, patients have not abused and possibly the added pressure make sure I fully inform and fully manage patient’s expectations. I find it so very rewarding to improve trust and communication even when their are rough times after surgery. I hope to continue this service my entire professional career!

I am very pleased with the results of less invasive procedures using interspinous implants. Much shorter surgeries,less infections,and rapid return to activities such as golf and tennis. Patients with advanced stenosis should understand implants give the support for the spinal elements. So many failed surgeries are a result of not using stabilizations in concert with decompression. This very important when there is a slip or spondylolithesis. Patients should expect one day hospital stay and early increase in activity. I still only recommend surgery after failed therapy,injections,and medication.I always spend time discussing possible complications and their frequencies.I consider each patient’s unique qualities in making a final decision on type of surgery which is fundamental.

During the Holiday seasons several risks occur each year. The average weight gain exceeds 10lbs for most of u out there. Many of u are carrying Christmas Trees or trying to lift them upright. The load can cause a sudden force great enough to rupture a disc. Think before lifting and get help with each project. Stringing lights also a risk. As far as all the great food and drinks, cut back portions or avoid one meal a day to balance a big dinner or office party. Try to exercise 45 minutes each day can be a big help as well.Remember,u do not want to ruin the holidays with injuries. Be careful cutting things such as wrapping paper or even a turkey in a hurry. Finally, mad and crazy driver r out there rushing to the next big sales event!

Patient should always do their research! When doctors make claims of great success try to look at all options. However, remember there is a body of knowledge as a basis for much of the outcomes for surgical procedures.I try to show and explain to my patients goals of 70 to 80 percent are reasonable and try very hard to manage their expectations.Claims of a 100 percent should be suspect.Any procedure has real risk that should also be carefully reviewed by your surgeon. Having said all this, patients should remain optimistic as most procedures for acute disc herniations or spinal stenosis are quite successful with timely return to normal activity.

I just return from an advanced spine meetings and want to report my observations.Patients should understand the best improvements after surgery still fall far short of a 100 percent. Even with new technologies, the number of patients with less then 70 percent improvement of their back or leg pain is still the challenge for surgeons. I always spend extra time making sure I explain realistic goals. Unfortunately, we do not have a perfect solutions for back or leg pain due to spinal pathology. Patients going to centers with claims of 90 to 100 results should be very wary!

I am amazed how often patients come to me with misinformation about their condition. They have their own notions about their spine problem and want me to accept a type of surgery that will not work. In particular, if they already know of a procedure that someone else claimed worked for their friend. After 22 years of seeing numerous failed procedures, I try to offer real opportunity for succcess. Unfortunately, this may require placement of devices in spine and two to three days in hospital but the outcomes r well worth compare to unproven gimmick ! Patents obtaining recommendations should then do research on doctor’s credential and look at published outcomes.

I have recently performed a number of revision surgeries and find that results can be very rewarding to patients that have given up hope. Usually, there is a residual area of compression of the spinal nerves that must be released. This requires extensive testing and thought before embarking on another surgery. However, results can be gratifying.

I find it very gratifying to help patients that have had failed back surgery. Many can be helped with new technology and careful review of symptoms and physical examination. Last week, I performed five surgeries with excellent early outcomes . Patients should not give up hope.Please always bring your records of op operative reports or pain management treatments to your office visit. Many failed surgeries are the results of simple outpatient procedures that were never a reasonable options and doomed to failure . Be careful with unproven laser claims or other procedures that can not be validated with scientific studies!

I continue to see patients that have been sent to pain clinics for first-line treatment of back or neck pain. Unfortunately,many are not examined and just given drugs or injections. In many cases,they come to need these drugs too often. The issue is diagnosis and then treatment! The newer less invasive spinal procedures can eliminate the need for excessive narcotics. I am amazed that diagnosis such as signal stenosis is so poorly diagnosed when these procedures give such great outcomes. Please consider all your choices!

Patients should understand that the cervical spine( neck) is much more forgiving when there is compression from a disc or spinal stenosis. One major reason is the load on the neck is about 8 pounds from the head. Therefore,many non- surgical options may be helpful including medication,therapy, traction to name a few. However, when pain radiates into arms or there are associated balance issues then more aggressive treatment may be necessary.Unfortunately, there is a point when these symptoms may not recover if removal of blockages due tio arthritic spurs or disc are not surgically removed. The good news is that smaller incision less then two inches from the front of the neck can be performed with very rapid recovery.Again, only for reasonable failed conservative treatment.Most patients are extremely gradified with their results.