Spine Surgery

[masterPain]

After reading about Tiger Woods undergoing 6th back surgery, what is your experience with patients in your practice who undergo spine surgery?

Clearly there are different types ranging in invasiveness, however, overall how do you see them do? I know there’s a pretty negative connotation in regards to spine surgery among the pain physicians. Hence, we typically deal with the aftermath of the bad outcomes.

Do you guys see a lot of successes where people just have one surgery and are near normal again?

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[callmeanesthesia]

After reading about Tiger Woods undergoing 6th back surgery, what is your experience with patients in your practice who undergo spine surgery?

Clearly there are different types ranging in invasiveness, however, overall how do you see them do? I know there’s a pretty negative connotation in regards to spine surgery among the pain physicians. Hence, we typically deal with the aftermath of the bad outcomes.

Do you guys see a lot of successes where people just have one surgery and are near normal again?

Yes. Conservative local surgeons though. And the caveat that they don’t come back to tell me they’re fine, but I see plenty who had surgery for one area and tell me they’ve had no problems since but are seeing me for another, or patients who had great relief from a discectomy but then re-herniate and are sent for ESI. Many where the radicular/claudication pain they had preop is resolved but they continue to have or eventually develop axial adjacent pain.

 

[bedrock]

After reading about Tiger Woods undergoing 6th back surgery, what is your experience with patients in your practice who undergo spine surgery?

Clearly there are different types ranging in invasiveness, however, overall how do you see them do? I know there’s a pretty negative connotation in regards to spine surgery among the pain physicians. Hence, we typically deal with the aftermath of the bad outcomes.

Do you guys see a lot of successes where people just have one surgery and are near normal again?

Of course. Spine Surgery has its role.

In order of best spine surgeries to recommend to patients-

1- a well performed lumbar laminectomy is a great surgery.

2- cervical disc replacement for single large disc herniation in younger patient with significant weakness and or persistent radicular pain after multiple CESI.

3-lumbar discectomy has more risk because potential of reherniation and or nerve root scaring, but a still reasonable to do for large disc herniation with significant weakness or significant persistent pain after multiple ESI (not modest radicular symptoms).

4- 1-2 level ACDF. In good surgical hands, solid outcomes. But shouldn’t be used for mild radiculopathy.

The clear majority of patients do very well with just one of those 4 surgeries.

It’s the lumbar fusions and long posterior cervical fusions where things most frequently go wrong and patients regret many (not all) of those operations.

 

[willabeast]

The data are not good for more than 3 back surgeries same area. But...I knew one spine surgeon who seemed to do no wrong. He was that 1 in a hundred who always got good results. If he thought he could help someone with a fourth spine surgery I would believe him.

 

[Ducttape]

work long enough and you will see a plethora of patients who had laminectomy or discectomy 20-30 years previously who had been "fine" until a recent development of pain.

you will get quite a few people that you refer for surgery that dont come back.

and on top of those, there are tons of people who never need pain management

typically, its the simple single level laminectomies or discectomies or cervical ACDFs that do well.

 

[jsaul]

I see many patients who are between 55-75 years old who had 2-3 level lami's several years ago that I do RFAs on now.

 

[SpineandWine]

Spine surgeons have good outcome for radicular pain.
More than 90% surgeries do well

Lumbar fusion leads to chronic pain

@bedrock, based on sports trial, my understanding of reherniarion after discectomy was 5% or less in non obese patient. Agree with bedrocks assessment on surgery

Selection bias- spine surgeons think epidurals don’t work since they see failed ESIs