If you are contemplating spine surgery, you may be interested to know what an orthopaedic spine surgeon recommends you consider—including, important questions to ask. This is a continuation of SpineUniverse’s interview with Ralph Rashbaum, MD.

SpineUniverse: Can you give us an insiders’ view on the best way to choose a surgeon?

Dr. Rashbaum:
First and foremost, do the research on the surgeon you’re considering. This way, when you go in, you will be well informed. What’s their experience? How many surgeries has he or she done? 

• Now which is better, a surgeon who’s done one surgery or a surgeon who’s done several hundred? Obviously, experience matters.
• Also, when a doctor suggests surgery, you need to ask why and find out if there are alternative treatment options.
• Most important, if there are other treatment options, you need to get a second opinion.

The second opinion will either confirm or negate the need for surgery. You can even get a third opinion, but more than three opinions probably aren’t necessary. And remember, most spine surgeries that are performed are elective. One of the ways I try to put things into perspective is to ask patients, You know why they call it back surgery? Because you keep coming back.

SpineUniverse: Do you consider multiple back surgeries inevitable? In other words, if you’ve had one, you’ll probably have another?

Dr. Rashbaum:
Your first surgery is usually just your first surgery. Over your lifetime, you will have more surgery because that first surgery alters the mechanics of the spine, and it inevitably accelerates degeneration at the segment that’s been operated on. It may take one year or it may take 30 years. But chances are, you’ll be back. It’s an aging process. Even without surgery, the spine is subjected to significant structural changes, some of which occur early on for no apparent reason and others later in life because of wear and tear.

SpineUniverse: It’s been a lively discussion. Is there anything else you’d like to add?

Dr. Rashbaum:
The resounding footnote should be–when in doubt, get a second opinion.

• If the complexity of the surgery that’s proposed is confusing, get a second opinion. Never hesitate to ask the doctor a question, and if that answer is not forthcoming, get another doctor.
• The best thing to do is not have spine surgery.
• The indication for necessity in every case is progressive loss of function, either by paralysis or by such physical incapacitation that you can’t function.

We talked about fracture, tumor, infection, instability and progressive neurologic deficit. Those five diagnostic situations account for fewer than 10% of the reasons we do spine surgery; 90% is done for “my back hurts.”

Patients, if at all possible, need to be in the best shape they can be before surgery. If they’re obese, they need to lose weight on a supervised diet. It’s not that obese people can’t do well; the typical problem is that they do not rehabilitate well because they never moved before they had this problem, and they’re not moving after because they have an impediment of surgical pain. Sometimes I will insist on weight loss and smoking cessation. We want our patients truly engaged in their healthcare. Remember, if you’re going to have back surgery, you’re going to be coming back.