Most of the spine surgeons I know are very decent people who give the same recommendation to each patient that they would give to a family member. I have seen, first hand, many of the horror stories about doctors perscribing the surgery that's good for them instead of the one that's good for the patient. That said, I still believe that most of them are good people who got into medicine for the right reasons and manage their patients and their practices as best they can with the harsh realities of modern medicine and the uncertainty of spine surgery.
Spoken to every failed spine patient, the statement that the surgery should not have been done and conservative treatment would have been better, will most likely be true. The flip side of that is that so many successful patients would have lived more years in pain instead of having their successful surgery, and possibliy given up higher chances for success as their pathology worsened.
The reason that more conservative treatment was done in the past is because the surgical offerings were more horrific, less successful. There were no options in between conservative treatment and brutal fusions. Fusions have become less brutal, hardware has improved, as has patient selection. Intermediate treatments have provided excellent relief for many; with discectomies, micro-discectomy, endoscopic discectomy, interspineous devices, dynamic stabilization, ADR, nucleus replacements, facet replacements, biologics, etc... We now have so many other options besides PT and meds, versus the brutal fusion - AND if you need a fusion, those are better too.
Unfortunately, there is still such a randomness to failed spine surgery that we will continue to hear the horror stories over and over. I don't know if we'll ever get past this. I have seen clients with failed surgeries that may have been avoided. Their experiences will help me to keep future clients in similar situations from making the same mistakes. While our odds may seem like they keep improving, but I believe that we are close to a wall that represents the randomness and lack of understanding we have about pain and structural issues, especially in difficult situations. (I still see occasional, seemingly perfect candidates fail.)
Sorry for the long rant that may even be off topic. I too don't trust the data and have seen big money get in the way of effective medicine too many times. We are caught between so many competing interests and the players do not all have our best interests at heart. However, we can't lay it all on the evil empire of the money-motivated mega-corps or on the doc who "need to make the payment on their Porsche". Spine surgery sucks and under the best of circumstances, many of us will fail. If you can avoid going down the surgical path, by all means exhaust every reasonable possibility (without putting yourself at too much risk.) If you need to have surgery... do your homework... make informed decisions.
Mark
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