'Spine surgery never works' — 7 spine surgeons on how to approach common misconceptions


Seven spine surgeons weigh in on the most common stigmas surrounding spine surgery and how they deal with patients who misconstrue spine care.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What are some best practices for controlling spine surgery costs?

Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, June 21, at 5 p.m. CST.

Question: What are some common misconceptions patients have about spine surgery and how do you correct those assumptions?


Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): The most common misconceptions are "spine surgery never works" and "many people are worse after spine surgery."


Jeffrey C. Wang, MD. Co-Director of the USC Spine Center at Keck Medicine of USC (Los Angeles): The most common misperception is that spine surgery does not work. There is clear evidence that spine surgery for definitive pathologies is beneficial, and for many problems, superior to conservative treatments with outstanding outcomes. Complications will happen in a small percentage of cases, and for that small percentage of patients who have complications — oftentimes not related to any problems caused by the individual operating surgeon — the experience will be sensationalized and misrepresented by the media and public. This misinformation is not helpful to the vast majority of patients who can benefit significantly by appropriate and evidence-based spine surgery and care.


Edward Rustamzadeh, MD, PhD. Spine Surgeon at Premier Brain and Spine Institute (San Jose, Calif.): Unfortunately, spine surgery has one of the worst stigmas associated with a specialty in all of medicine. I believe this has to do with the misinformation that is readily available to patients at a click of a keyboard. There are too many horror stories posted on the internet from patients. I do not want to discredit all of these comments, but too many are filled with factual errors and just plain and simple retribution of the patient to their treating surgeon. Too many times these patients do not have the moral fortitude to directly deal with their surgeon, and the internet provides an easy and cowardly out for them.  


If it isn't the internet or social media, then there are the patients who I see in my clinic who either know of someone who has had spine surgery or have heard of someone who had spine surgery with a poor outcome. I have to remind the patient that they do not know what that particular patient's diagnosis was, who operated on them and what occurred postoperatively. We as humans will more readily accept the worst possible outcome than entertain the possibility that we are wrong in our assumptions.  


One of the other misconceptions that patients have is that there is a possibility of "laparoscopic spine surgery or laser spine surgery." I have to inform them that laparoscopic surgery is performed by general surgeons not spine surgeons, and that no reputable major teaching academic center that I know of performs laser spine surgery! Then I pose the question back to the patient "Why do you think that is?"


Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Some of the biggest misconceptions that I hear about spine surgery are that it doesn't work or that there is a high risk of complications. I spend a large part of my day counseling patients that spine surgery is very effective so long as we are careful in determining who would be a good candidate. Furthermore, I make sure patients understand that these procedures are very safe and often have lower risks of complications than other commonly performed surgeries, such as hip or knee replacements.


Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I think the public's perception to spine surgery, in general, is apprehension. I think it happens because of the history of spine surgery. In the past 15 or 20 years, a lot of spine surgery was done by people who weren't trained in the discipline of spine surgery. The average neurosurgeon did mostly brain surgery in his/her training and very little spine surgery. Nowadays, people have training where they are dedicated to more precise spine care. I think that's the main thing you've got to understand as far as the misconceptions go about spine surgery.


J. Brian Gill, MD. Spine Surgeon at Nebraska Spine Hospital (Omaha): Some common misconceptions that I hear from patients are that back surgery does not work and people are worse than where they were prior to surgery. Many studies have refuted this misconception especially in regards to degenerative spondylolisthesis with associated spinal stenosis and disc herniations. I sit down with each patient and discuss expectations that they have regarding their symptoms and what they can expect from a surgery. Miscommunication between the surgeon and the patient is where misconceptions start. I try to counsel each patient with realistic expectations.


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Unfortunately, one of my favorite Bulls players from the 90s dynasty, Steve Kerr, had a really difficult time and continues to have problems. Many patients' first words are: "I don't want to have surgery." That's fine and I don't get discouraged. Their common misconception is that I am going to want to operate on them before they even sit down for the consult. I take my time, get updated studies and make sure the indications are there. And a majority of the time, I don't operate on them.


The second misconception is that they will be in agony postoperatively. Patients are sometimes in a lot of discomfort after their surgery. More often than not they have a pretty reasonable amount of discomfort. Also they tend to be off of pain pills about one to three weeks afterwards, but usually not if they were on very high doses preoperatively. Those patients do tend to take less.


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