Nov 21, 2017

When a surgeon recommends an operation, it is generally a good idea to get a second opinion. Not all surgeons are alike. Different surgeons look at spine problems differently and there are multiple ways to get a good result. It helps a patient to get another perspective on the problem, including recommended options and possible outcomes.

Surgical recommendations depend on the surgeon’s training, experience with the specific problem, success rates, clinical studies, risk factors, and the expectations of the patient. Often, a second opinion can be different from the first. The more complex the problem, the greater the variation between the first and second opinions.

Although the approach may vary and surgeons might differ on the levels to be operated on, the type of instrumentation to use, or post-operative care and recovery, there should be some consistency in the diagnosis and the conclusion that surgery is indicated.

For example, we know that a decompression surgery (discectomy, laminectomy) will not help back or neck pain. Fusion surgery recommendations based on MRI findings without confirmation of the pain generator will often be unsuccessful. In general, decompression operations, to help leg pain or arm pain, are more successful than surgical treatment of chronic back or neck pain.

Inconsistency in the diagnosis or the reason for surgery means that surgery should be avoided until more information is gathered to help make the proper diagnosis.

Some surgeons would rather not schedule a second opinion visit. They take a lot of time and may not result in the patient undergoing the procedure with the second opinion surgeon. However, if a second opinion helps the patient avoid unnecessary surgery, it is well worth the time spent for both the short and the long-term.

Personally, I continue to participate in second opinions as long as it is requested by the patient’s referring or primary care physician. Primary care doctors often know which spine surgeons can help patients get the most appropriate care. This can save time, reduce medical costs and minimize stress for the patient.

My recommendation is that patients understand their spine diagnosis as completely as possible. They can find information on reputable websites or in candid discussions with their primary care physician and surgeon. When patients fully understand the problem, they can make a more informed decision. This should include understanding how changes in healthcare policy and treatments could influence insurance company approval of their spine surgery.

The bottom line is that if a major spine operation such as a fusion is recommended, and the diagnosis and indication are not clear, ask your primary care physician to refer you to another surgeon for a second opinion.