How to chose back surgery and the surgeon

I hope that you never need to have back surgery but sometimes it is necessary. If so, then you might want to read the Q and A with the director of the Dartmouth Institute for Health Policy and Clinical Practice, James Weinstein.

from ConsumerHealthReports:

….Our survey found that those who underwent discectomies were significantly more satisfied (69 percent) than those who underwent spinal fusions (56 percent). If one surgeon recommends a fusion and another, simple discectomy, how do you know which operation is right for you?

When it comes to spinal surgery, less is more. Most patients in my practice come in for a second or third opinion, and I rarely recommend a fusion. If a fusion is a consideration it requires a lengthy discussion of risks—including longer hospitalization and blood transfusion—and an understanding of the rehabilitation involved. Patients need to know that they do have a choice, and their preferences and values matter.

More than a quarter of the respondents in our survey said they had not been informed about the risks of surgery, such as nerve injury, bleeding, and infection. How is that possible?

It is unfortunate that shared decision-making and true “informed choice” is not the norm. Patients want and deserve to have meaningful information presented to them about risks and benefits, particularly in cases in which treatment options are a toss-up.

What about minimally invasive techniques and other new technologies?

There are many new technologies available, and they are confusing to patients and their families. Knowing your doctor’s experience and his or her results using these technologies is important. Patients should also ask if their doctor is involved in any way with the companies that produce equipment used for surgeries. This is not always an indicator of a conflict of interest, but a good surgeon will willingly disclose any involvement, however slight.

What about artificial disks?

The evidence for multiple-level disk replacement is less than adequate. The evidence for artificial disk replacement for back pain is still evolving. Patients should be cautious about new technologies generally. Because they are available elsewhere doesn’t mean they are necessarily better, or that they are safe and effective.

How long does recovery take after lower-back surgery?

Twelve weeks seems to be the magic number (in order to avoid recurrence), but it really depends on the patient’s job. A heavy laborer will require 12 weeks or more, but some sedentary workers return to work after a week or two….

more at ConsumerHealthReports


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