How Imaging is leading to unnecessary surgery
It’s been a while since our last newsletter. My feeling about medicine has become more focused at this point and time. I have seen a large number of people coming into my office, who have been recommended spine surgery by either spine surgeons, neurosurgeons or orthopedics who have basically recommended surgery because of imaging. Imaging is a double edged sword and this tool is something most people hang their hats on. If a patient is never examined by the physician who wants to operate, then the patient will have a false diagnosis based on an MRI.
35% of normal people off the street will have an MRI that has some detail indicating a surgery is required when there is nothing wrong with the patient on exam. Multiple studies were performed and have validated this statistic after MRI’s came to the market after 1989.
When surgery is recommended by a physician, there are certain standards for which surgery is done. If one is to perform a laminectomy for a herniated disc, the disc has to have pressure on the nerve root causing leg pain, not back pain. Mostly arm pain, not neck pain. If there are no neurological deficit, no reflex changes, no muscle weakness, no sensory loss and it’s just neck pain; an MRI with a degenerative disc that can be seen in such a high percentage of people (neck and back) then it’s a FALSE DIAGNOSIS.
One must find a second opinion as quickly as possible, because the heightened anxiety of a surgeon telling a patient “ you will get paralyzed if you don’t have this surgery” is totally fraudulent. This happens all over major South Florida hospitals unfortunately and many doctors have for some reasons have become predatory technicians. We as surgeons are doctors 1st. We take care of patients the best way we know how. There are many conservative treatments that can be done before surgery. If those surgeries are necessary and all conservative treatments have been completed, so be it.
I have often said it’s either OUTCOME or the INCOME. In today’s healthcare environment it seems the INCOME is more important than the outcome. If you saw how many patients I see with failed surgeries a year or two after the surgery, WITHOUT the criteria I mentioned, you would be amazed how much they go through with pain medications and reduced quality of life.
The benefit of appropriate physical therapy
Another issue that I feel is important for my patients and referring physicians to understand is the importance of physical therapy. Physical Therapy is magic!
Physical Therapists are most highly trained, more so nurses and just behind physicians. They have had 4 years of training including anatomical dissection and one year of post graduate hands on experience.
What does Physical Therapy do?
Physical Therapy restores flexibility in certain muscle groups. The gluteal muscle, the hamstrings, etc..Flexibility is important to restore especially if one has injured a muscle. Strength is also important. As we get along in years and approach 50 and 60 years of age, many people can’t even get off the floor because their muscles are so weak.
For spine, my biggest issue is the weakness of the core muscles. We grade muscles on a 0-5 scale.
- If it’s 2 over 5, you can’t move against gravity,
- 3 over 5 is weak and so is 4 over 5
- 5 is considered normal.
To perform a full sit-up proves structurally that your spine is ok. If you can’t do it because your muscle are weak, that MUST be addressed. If the doctor that is writing the prescription, can’t address that, the physical therapist will not know what to do
So what happens is a patient will blow through their physical therapy visits without a success. Just because it failed doesn’t now mean the patient needs pain injections or surgery. Be aware that the therapy is done correctly and the prescription is written correctly. Many doctors do not understand correct therapy and most write “Rehab as necessary” leaving it up to the physical therapists to make the decision and that is not always the best way to go.
