Surgery is not the “final answer” for back and neck pain.
Why? Well, put simply, one bad thing leads to another bad thing. Think of an injury. Injuring your ankle creates a weakness, which makes a future injury more likely. Similarly, I believe that one spine surgery frequently leads to more spine surgeries. It’s a complex topic and there are several factors that contribute to the high frequency of reoperations amongst spinal surgery patients, the biggest being that most who undergo it aren’t actually candidates for the surgery.
This is not to say that surgery is never the answer. There are times in which IT IS, in fact, the best treatment and a second surgery is never needed. But, before you undergo the knife, you should first consult a specialist other than a surgeon — specifically a neurologist.
Here are four main reasons why you need to see a neurologist for your back and/or neck pain before seeing a surgeon.
1.) Many Surgeons have an inherent “lean” toward surgery.
Surgeons will order diagnostic tests like MRIs and x-rays, just like a general or family doctor can. The difference is that surgeons can’t help seeing every patient through the lens of their most powerful tool: “Can surgery help this patient?” Looking at a problem through these lens causes them to overlook other, nonsurgical treatments. Thus, even the best surgeons may recommend an unnecessary surgery.
2) A neurologist is highly specialized in diagnosing back pain and neck pain, and in assessing risks and treatment options.
Every back pain and neck pain patient is unique, with different degrees of problems associated with a bone or disc abnormality. A neurologist is trained to discover the causes of symptoms, as well as using EMG testing to assess the injury to nerves and whether it is reversible in the short and long term.
However, conflicts in assessment can come in if a neurologist sees a patient sent to them by one of their surgical friends working in the same hospital system. On the one hand, he/she has a primary duty to the patient to provide the best care possible. On the other, the neurologist’s salary might be paid by the hospital system, which receives compensation, as does the surgeon, when surgery is done.
To have a true and unbiased second opinion about whether surgery is necessary, it’s best for you to see an independent neurologist or, at least, one in another hospital system. In most non-emergency cases, a conservative approach is both possible and optimal.
3) Independent neurologists can provide the most informed and trustworthy referral to a surgeon.
Unfortunately, some patients can’t be helped by non-surgical treatment, even when receiving the best care. Disc herniation can be too extreme, bone can build up around nerves to the point where they no longer fit through. But, an independent neurologist who has seen thousands of cases will be able to refer you to best surgeon for your case, one who will be able to perform the surgery you actually need.
4) Neurologists make a long-term connection with patients.
Surgeons don’t generally care for patients with back pain and neck pain over the long term. The last time you see your surgeon is likely during a follow-up visit a month or two after surgery, long before you are fully recovered. There are a plethora of cracks to fall through, later on, the most important being a return to the same posture and muscle conditioning that led to the injury in the first place.
If a surgeon refers you to physical therapy at all, he’ll leave it up to you to pick a physical therapist off the internet. Not only will the therapist you find be a generalist, but they will also have little more to go on than a few words about the type of surgery you had.
Back injuries are a long-term problem, and to fix them requires a great deal of commitment from the patient. That commitment can keep you healthy and out of surgery, but you can’t do it on your own. You need nurses, physicians, and physical therapists to support you all along the way. If you start with a Neurologist, you will have the continued support of someone who understands your case.
Starting with a neurologist to discuss your back pain will give you a very different experience than starting with a surgeon. We will first evaluate your case and get you a precise diagnosis. Once we have your diagnosis, we can recommend the best treatment. Sometimes it’s surgery, sometimes it’s going through nonsurgical reliefs such as changing your sleep position, physical therapy or fixing your posture. In the end, regardless of the treatment we prescribe, you will be able to have the confidence that it’s the right one.
Experiencing chronic back pain? If you are in the Kansas City area, visit me at Rowe Neurology Institute and we can begin the process of evaluating your situation. If you’re not local, read my article on the 5 facts you should know BEFORE you get tested for the things to consider before you see a neurologist.