According to what Stuart McGill says in his book “Back Mechanic: The secret to a healthy spine your doctor isn’t telling you”, he claims that back surgery is overprescribed. In part one of this post I talked about the importance of exhausting all non surgical methods before even considering surgery. A comprehensive and thorough assessment should be the first thing that a trainer/coach, physical therapist, Chiropractor, physician should do.
So now that we understand those two main points from part one, what happens next? What should a person look for in a surgeon if it’s determined that the patient is a good candidate for surgery? Here, according to McGill are 9 things to keep in mind
When Selecting A Surgeon:
1-Take matters into your own hands and ask around. Start by asking the nurses and physical therapists at the hospital which surgeon has the best results.
2-All surgeries have a risk and no surgery is without risk. You must understand what is the long term success rate of the surgery, as well as the risk and the benefits. Specifically what do the long term results look like?
3-Find a surgeon who specializes in spine surgeries and who has experience with many spinal surgeries (100 or more).
4-Be careful about “Surgery Up-selling”! For example “I always operate on the neck before I operate on the back”, if you hear this then look for another surgeon.
5-Proposing multi-level fusion in the lumbar spine is a red flag, look for another surgeon. Fusing one or two levels is reasonable in very severe degenerative cases, but multi-level is rarely necessary.
6-Good surgeons will discuss: Alternatives, options, risk/reward. Be careful of surgeons who do not offer non-surgical treatment options.
7-Be careful of surgeons who are perturbed by you asking questions! Good surgeons won’t mind answering questions and in most cases will encourage it.
8-Don’t be a guinea pig! If a surgeon has never done a particular kind of surgery then find a different surgeon.
9-If/When the first surgery does not work, be VERY skeptical of a surgeon who wants to do it all over again. If it didn’t work the first time then the person probably didn’t need it in the first place.
Further Consideration
There are definitely other things that one can add to this list. Personally, I would ask the surgeon if I can talk to a couple of their former patients, and ask them about their experience, how satisfied they are etc. When I was considering surgery for my torn meniscus I spoke to a couple of people who had a common surgeon. They had positive things to say, and when I asked the surgeon about them he also responded positively.
I would also discuss the pain with the surgeon and see if we can determine what the “pain generator” as McGill call it. Then I would ask if it’s possible to cut out the pain generator.
One thing in particular that McGill mentions in his book that really stuck with me is: The more tissue that is involved the lower the success of the surgery. For example, damage to multiple levels of the spine means that the likelihood the surgery will be a complete success is lower.
Final Thoughts
I completely believe that McGill is right when he says that the patient should be an ACTIVE PARTICIPANT. People should be educated and informed about the procedure, risk, reward, success, options etc.
It seems to be the case that when it comes to authority, and specifically medical authority, people accept things without question. Especially when they have been living with chronic pain. The possibility, no matter how small, that the pain will go away can become very tempting. The person in the position of authority has to know and keep in mind that they have someone’s fears and lively in their hands. I’m sure most people can recall or have heard of stories involving medical malpractice. And sometimes, those cases involve patients who were not as outspoken as they ought to be.
At the same time, how much of the responsibility of knowing falls on the patient? Considering the power dynamics between the patient and the authority, I would say that the authority has the burden of responsibility. The authority has the burden to explain to and inform the patients of what is involved.
Personally, I believe that the person must not only come out feeling better, but also more empowered and educated. The person should be informed enough to understand what the pain mechanisms and triggers are, what to do if they start to experience the pain. In short, the person should have no issues taking back control and agency over their recovery as much as possible.