Opinions on spine surgery

[nopain1234]

I had an interesting conversation with an academic guy the other day who essentially doesn’t believe in spine surgery whatsoever. He went on to say neurosurgery is kind of a sham specialty where they essentially only decompress things (and not fix/treat anything).

Clearly an extreme individual, I’ve seen some success stories and horror stories from spine surgery. I wanted to get your opinions

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[lobelsteve]

More info on the academic guy. Clearly some type of pathology in that one.

 

[Doctodd]

So electricians are scam artists too? Cuz it’s the same concept. Decompressing a nerve does fix a structural pathology.

 

[Agast]

Lol “doesn’t believe in spine surgery”

Life and gravitational pull does not care what you believe in

 

[MitchLevi]

I had an interesting conversation with an academic guy the other day who essentially doesn’t believe in spine surgery whatsoever. He went on to say neurosurgery is kind of a sham specialty where they essentially only decompress things (and not fix/treat anything).

Clearly an extreme individual, I’ve seen some success stories and horror stories from spine surgery. I wanted to get your opinions

Not the surgeon's fault Mr Jones still has leg pain after a well-done laminectomy, or when Mrs Smith has chronic radic after an L4-5 laminectomy and fusion for her severe spinal stenosis and 8mm dynamic spondy.

 

[deleted875186]

I had an interesting conversation with an academic guy the other day who essentially doesn’t believe in spine surgery whatsoever. He went on to say neurosurgery is kind of a sham specialty where they essentially only decompress things (and not fix/treat anything).

Clearly an extreme individual, I’ve seen some success stories and horror stories from spine surgery. I wanted to get your opinions

I don’t think multilevel fusions are appropriate, although some people do seem to get at least temporary symptom relief.

I have no issue with decompressive laminectomies and micro disks, I would get one if I needed it.

 

[Ducttape]

decompression in patients with severe compression disorders (spinal stenosis, significant disc herniation) does "fix" things...


issue of surgery for pain is different. in this situation, surgery to alter the suspected root cause may not affect pain pathways or pain processing, and thus be ineffective in pain management.

 

[Analgesia108]

I had an interesting conversation with an academic guy the other day who essentially doesn’t believe in spine surgery whatsoever. He went on to say neurosurgery is kind of a sham specialty where they essentially only decompress things (and not fix/treat anything).

Clearly an extreme individual, I’ve seen some success stories and horror stories from spine surgery. I wanted to get your opinions

Hope this 'academic guy' never needs spine surgery.....

 

[Ferrismonk]

A microdisc/laminectomy is okay for severe stenosis with radicular symptoms not resolved with more conservative measures. Fusion is reasonable for a truly unstable spine. Other than that, I don't recommend spine surgery outside of trauma, infection, tumors.

Even a laminectomy destabilizes the spine and will lead to other problems later on though. I have never seen someone who had surgery and was better forever.

 

[nvrsumr]

Buddy of mine is an ivory tower type. Residency and fellowship director. Told me last week there is no such thing as SI joint pain.

 

[callmeanesthesia]

A microdisc/laminectomy is okay for severe stenosis with radicular symptoms not resolved with more conservative measures. Fusion is reasonable for a truly unstable spine. Other than that, I don't recommend spine surgery outside of trauma, infection, tumors.

Even a laminectomy destabilizes the spine and will lead to other problems later on though. I have never seen someone who had surgery and was better forever.

They don’t come see you if it made them better forever…

 

[Bostonspine]

Buddy of mine is an ivory tower type. Residency and fellowship director. Told me last week there is no such thing as SI joint pain.

There isn't if you never follow up with your patients and someone else is finding them.

 

[bedrock]

Buddy of mine is an ivory tower type. Residency and fellowship director. Told me last week there is no such thing as SI joint pain.

wow,.......and scary that he is teaching fellows there is no SIJ pain.

 

[Ferrismonk]

They don’t come see you if it made them better forever…

lol, true. I meant even friends and family though.

 

[kstarm]

Buddy of mine is an ivory tower type. Residency and fellowship director. Told me last week there is no such thing as SI joint pain.

So what does he think is causing pain instead of the SI joint (for what we might call typical SI joint pain)?

 

[nvrsumr]

I didnt ask. One of his residents is writing up a case for me and just came up in an email.

I do think there is a legit question if what we commonly diagnose as sacroiliitis is really some type of posterior sacral ligament pain.

 

[drusso]

Spine surgery is completely useless except when it's needed.

 

[Ferrismonk]

I also know someone who swears SI joint pain doesn't exist too. He thinks pain in the sacral area is referred from lumbar facets or is sacral nerve root mediated. I am 100% sure this view is in no way influenced by the fact that facet and epidural procedures pay more.

 

[Orin]

Clearly an extreme individual, I’ve seen some success stories and horror stories from spine surgery.

The academic guy only sees the horror stories as there is an IR/spine/etc guy doing the easy stuff.

This leads to classic experience bias when you only see the trainwrecks, like the spine surgeons who hate interspinous spacers.

 

[deleted875186]

Not to hijack thread, but what is the deal with TLIFs, do they just reimburse much more than a multilevel lami. Neurosurgeon in my hosptial system seems to exclusively do TLIFs. For instance, even the 80 year old healthy patient with one level severe stenosis who is miserable even after multiple LESIs who I referred to see if they were a candidate for a lami, and the surgeon offers to do a TLIF.

Anecdotally the patients seem to do a bit worse than a typically decimpressive lami. Anyone else have experience seeing these patients? I’m assuming there must be some neurosurgery literature suggesting it’s a good approach.

 

[Taus]

Not to hijack thread, but what is the deal with TLIFs, do they just reimburse much more than a multilevel lami. Neurosurgeon in my hosptial system seems to exclusively do TLIFs. For instance, even the 80 year old healthy patient with one level severe stenosis who is miserable even after multiple LESIs who I referred to see if they were a candidate for a lami, and the surgeon offers to do a TLIF.

Anecdotally the patients seem to do a bit worse than a typically decimpressive lami. Anyone else have experience seeing these patients? I’m assuming there must be some neurosurgery literature suggesting it’s a good approach.

Yup

 

[RoloTomassi]

Can't always just do a lami without destabilizing the spine though. If a lot of facet has to be removed, or the disc is tall, or facet joint angle is very sagittal, doing just a lami can destabilize and they'd likely have to have a second surgery to fuse in the near future. Oh and if there's foraminal in addition to the central stenosis, lami won't help with that.

 

[TIVAndy]

i had an anesthesia attending who refused to do anesthesia for kyphoplasty based on NEJM study of no difference in outcome. he was very accomplished researcher and very nice guy btw.

on a side note, i do think SI joint pain is overdiagnosed, especially for the ones who want to fuse them.

 

[SSdoc33]

are there any joints in the body that all of a sudden don't have pain receptors? no.

 

[geauxg8rs]

i had an anesthesia attending who refused to do anesthesia for kyphoplasty based on NEJM study of no difference in outcome. he was very accomplished researcher and very nice guy btw.

on a side note, i do think SI joint pain is overdiagnosed, especially for the ones who want to fuse them.

It seems like PT and PCP like to call any pain in the buttock either si joint or piriformis syndrome

 

[geauxg8rs]

i had an anesthesia attending who refused to do anesthesia for kyphoplasty based on NEJM study of no difference in outcome. he was very accomplished researcher and very nice guy btw.

on a side note, i do think SI joint pain is overdiagnosed, especially for the ones who want to fuse them.

Even though the study was absolute crap? Should not have been published in the much esteemed NEJM (joking). I heard it got rejected from the local auto trader due to poor design.

 

[Ferrismonk]

i had an anesthesia attending who refused to do anesthesia for kyphoplasty based on NEJM study of no difference in outcome. he was very accomplished researcher and very nice guy btw.

on a side note, i do think SI joint pain is overdiagnosed, especially for the ones who want to fuse them.

Did he refuse all other surgeries he didn't agree with? As an anesthesiologist, that's crazy.

 

[TIVAndy]

Did he refuse all other surgeries he didn't agree with? As an anesthesiologist, that's crazy.

not sure about other cases but as a resident i was shocked

 

[TIVAndy]

Even though the study was absolute crap? Should not have been published in the much esteemed NEJM (joking). I heard it got rejected from the local auto trader due to poor design.

agree but can't do anything when he's your boss and i'm a resident

 

[DrMDAware]

It seems like PT and PCP like to call any pain in the buttock either si joint or piriformis syndrome

If I get another request for a piriformis injection….why yes I do love billing for a TPI

 

[nvrsumr]

Trans piriformis sciatic nerve block

 

[powermd]

Trans piriformis sciatic nerve block

What is that, like $4 more?

 

[avalon10]

It seems like PT and PCP like to call any pain in the buttock either si joint or piriformis syndrome

It's not always piriformis syndrome. Sometimes it's because one leg is longer than the other, or the hips are out of alignment.

 

[MitchLevi]

It's not always piriformis syndrome. Sometimes it's because one leg is longer than the other, or the hips are out of alignment.

Correct, it's virtually NEVER piriformis syndrome.

 

[avalon10]

Correct, it's virtually NEVER piriformis syndrome.

Correct, it's also virtually NEVER because one leg is longer than the other, or the hips are out of alignment.

I guess I should have noted that my comment was written in sarcasm.

 

[MitchLevi]

Correct, it's also virtually NEVER because one leg is longer than the other, or the hips are out of alignment.

I guess I should have noted that my comment was written in sarcasm.

By out of alignment, what do mean?

 

[avalon10]

By out of alignment, what do mean?

I have no idea what it means- but that's what physical therapists seem to tell people all the time.
Their low back or radicular pain is caused by one of the following:
1. Piriformis syndrome
2. One leg being longer than the other
3. Hips being out of alignment.

 

[MitchLevi]

I have no idea what it means- but that's what physical therapists seem to tell people all the time.
Their low back or radicular pain is caused by one of the following:
1. Piriformis syndrome
2. One leg being longer than the other
3. Hips being out of alignment.

Haha. My apologies. I thought you were saying that...

I can't convince ppl hip alignment isn't real.

 

[geauxg8rs]

I have no idea what it means- but that's what physical therapists seem to tell people all the time.
Their low back or radicular pain is caused by one of the following:
1. Piriformis syndrome
2. One leg being longer than the other
3. Hips being out of alignment.

Maybe a rib is out? Whatever that means. I keep hoping the patient really means that McRib is out again. But it never is the McRib

 

[10KHertz]

If you ask a reputable neurosurgeon his opinion regarding spinal surgery . They’d say it’s the easiest surgery they offer , and it’s typically the last option. No guarantees

 

[avalon10]

If you ask a reputable neurosurgeon his opinion regarding spinal surgery . They’d say it’s the easiest surgery they offer , and it’s typically the last option. No

A microdisc/laminectomy is okay for severe stenosis with radicular symptoms not resolved with more conservative measures. Fusion is reasonable for a truly unstable spine. Other than that, I don't recommend spine surgery outside of trauma, infection, tumors.

Even a laminectomy destabilizes the spine and will lead to other problems later on though. I have never seen someone who had surgery and was better forever.

Myelopathy is a reason to have spine surgery.
Radiculopathy with pain refractory to more conservative treatment is another.
Of course there are spine surgeries for tumors, scoliosis, etc as well.