The Rape of the Spine.

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lobelsteve

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Nelson. RJ. The Spine Journal 11s. March 2015.

http://www.thespinejournalonline.com/issue/S1529-9430(15)X0002-7


Full text available to NASS members and organizations. I'm not allowed to reprint it here.
It is s spine surgeon telling how other surgeons are committing fraud.

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good article.

I am SOOO thankful I trust my neurosurgeons.
 
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On an almost daily basis I am appalled at what I see surgeons in my area doing. Mainly it is ortho guys but there are two neurosurgeons who I know practice in a careless and greedy fashion as well. I have seen them doing multilevel fusions for SI joint pain with absolutely no disc pathology, axial low back pain with no instability, mild spinal stenosis, and the list goes on. I also have seen instances where a person clearly needs a two level lami and they do one wait 6 months and then do the other with fusion. One surgeon also tells his patients they need the hardware taken out about 80% of the time. It's sickening. I have patients who were told if they refused surgery they "would end up paralyzed". If the professional societies would have some balls and stand up against this maybe it would change but it's sickening what goes on and how people's lives are devastated by spine surgeons.
 
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On an almost daily basis I am appalled at what I see surgeons in my area doing. Mainly it is ortho guys but there are two neurosurgeons who I know practice in a careless and greedy fashion as well. I have seen them doing multilevel fusions for SI joint pain with absolutely no disc pathology, axial low back pain with no instability, mild spinal stenosis, and the list goes on. I also have seen instances where a person clearly needs a two level lami and they do one wait 6 months and then do the other with fusion. One surgeon also tells his patients they need the hardware taken out about 80% of the time. It's sickening. I have patients who were told if they refused surgery they "would end up paralyzed". If the professional societies would have some balls and stand up against this maybe it would change but it's sickening what goes on and how people's lives are devastated by spine surgeons.

A letter to the editor for NASS?
 
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It's more like, someone told the pt there's technically a chance it could happen and the heard whatever they wanted to hear.

I told someone last week that a car wreck or a fall down some stairs "could technically paralyze you man...Your cord is compressed at 3 levels and someone told you this in 2019 too..."

I trust virtually none of my pts to hear what's actually said to them.
 
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Speaking of spinal rape - I just got a request to see a 24 yo F PhD student s/p bilateral SIJ fusion with post op infxn.

I declined it.
 
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honestly is this something new? we all know it, they know it. how many times have your heard the spine surgeon say "if you don't do the fusion you could be paralyzed"
“Your epidural is a bandaid I want an actual permanent solution “
 
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Speaking of spinal rape - I just got a request to see a 24 yo F PhD student s/p bilateral SIJ fusion with post op infxn.

I declined it.
“But she’s in pain and you’re a pain doctor!”

/s
 
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On an almost daily basis I am appalled at what I see surgeons in my area doing. Mainly it is ortho guys but there are two neurosurgeons who I know practice in a careless and greedy fashion as well. I have seen them doing multilevel fusions for SI joint pain with absolutely no disc pathology, axial low back pain with no instability, mild spinal stenosis, and the list goes on. I also have seen instances where a person clearly needs a two level lami and they do one wait 6 months and then do the other with fusion. One surgeon also tells his patients they need the hardware taken out about 80% of the time. It's sickening. I have patients who were told if they refused surgery they "would end up paralyzed". If the professional societies would have some balls and stand up against this maybe it would change but it's sickening what goes on and how people's lives are devastated by spine surgeons.
I see surgeons operate for axial low back pain without Instability. To top it off it doesn't help you see all these Influencer surgeons posting anecdotes that their surgery for axial low back pain was helpful. When you read articles or textbooks they do not commit to saying if purely axial pain with no radicular pain or claudication then no surgery. Most articles I read suggest we really should consider surgery for this population.
 
In my group, you ain't getting surgery for axial LBP without a slip or severe spinal stenosis. Credit where it's due.
 
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“Your epidural is a bandaid I want an actual permanent solution “
I hear this sentiment often. People must think getting a multilevel fusion is like changing a flat tire…
 
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I hear this sentiment often. People must think getting a multilevel fusion is like changing a flat tire…
I do too. I explain the injection and their immediate response is “but that’s not gonna fix the problem doc”. I’ve heard it so many times that I’m very close to saying “nothings gonna fix the problem”
 
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I do too. I explain the injection and their immediate response is “but that’s not gonna fix the problem doc”. I’ve heard it so many times that I’m very close to saying “nothings gonna fix the problem”
I say it all the time.

Pain is by definition an emotional experience.
 
I do too. I explain the injection and their immediate response is “but that’s not gonna fix the problem doc”. I’ve heard it so many times that I’m very close to saying “nothings gonna fix the problem”
I tell them that the disc tear/herniation/stenosis/etc is not the problem. The fact that it's causing pain is the problem. So if we can fix the pain we don't need to "correct the issue". Also tell statistics about prevalence of non-painful facet arthropathy, disc degeneration, etc. I doubt it does anything, but it makes me feel better
 
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I tell them that the disc tear/herniation/stenosis/etc is not the problem. The fact that it's causing pain is the problem. So if we can fix the pain we don't need to "correct the issue". Also tell statistics about prevalence of non-painful facet arthropathy, disc degeneration, etc. I doubt it does anything, but it makes me feel better
Sometimes you get the wiseguy reply "but how can you fix the pain if you don't fix the underlying cause". I usually just tell them that modern medicine has only come so far and we only have a handful of treatments that can work
 
Pain and nociception are not the same, and pain is learned over time. It is the summation of all of your life experiences and for this reason we're all individual in our experience...Even with an identical MRI and identical severity (8/10 or 5/10, etc), everyone tells a different story.

Pain is not in every case clearly defined by specific anatomy or sensory neurons.

Pain is affected by social factors, biology, psychology, family, the economy, everything...

Any physiological stress at all can worsen or improve one's pain state. Let a man with CLBP go through a divorce or a bankruptcy or any of stressor and you'll watch his back worsen.
 
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Pain and nociception are not the same, and pain is learned over time. It is the summation of all of your life experiences and for this reason we're all individual in our experience...Even with an identical MRI and identical severity (8/10 or 5/10, etc), everyone tells a different story.

Pain is not in every case clearly defined by specific anatomy or sensory neurons.

Pain is affected by social factors, biology, psychology, family, the economy, everything...

Any physiological stress at all can worsen or improve one's pain state. Let a man with CLBP go through a divorce or a bankruptcy or any of stressor and you'll watch his back worsen.

If a doctor told me that my back pain was in my head, I'd be pissed...
 
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“ I want surgery.. I want it fixed!” 🙄
 
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I’m happy to have patients who want it all “fixed” go to my friendly neighborhood tertiary care center for their “expert care”

Many wind up coming back anyway…
 
I remember neurosurgeon who send patients with a "work order" to his usual referral pain doc for cervical mbb/facet injections to "avoid surgery". Guy had trip to Italy coming up and I had an opening before the trip so he came to see me. His exam and MRI was classic for cervical radicular pain. I did one CESI resulting in no pain and no surgery. Made me wonder how many times neurosurgeon orders wrong injection so that it fails and he can then operate?
 
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Nelson. RJ. The Spine Journal 11s. March 2015.

http://www.thespinejournalonline.com/issue/S1529-9430(15)X0002-7


Full text available to NASS members and organizations. I'm not allowed to reprint it here.
It is s spine surgeon telling how other surgeons are committing fraud.


This links to a presentation at a 2015 British spine society meeting. That makes sense. No way an American spine surgeon would criticize the industry from the confines of their beach house.
 
I tell them that the disc tear/herniation/stenosis/etc is not the problem. The fact that it's causing pain is the problem. So if we can fix the pain we don't need to "correct the issue". Also tell statistics about prevalence of non-painful facet arthropathy, disc degeneration, etc. I doubt it does anything, but it makes me feel better
I only get 15 minutes to see these patients. Sounds like this convo would take up 14.5 of them.
 
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