Academic Institution gives wrong diagnosis

January 3, 2019

I have had the opportunity to see many people in my office here in Coral Gables, Florida over the years. One that comes to mind specifically, is a 70 year old man who actually happened to be someone that I have known in the South Florida area.  He has had a procedure in his lower back by another spine surgeon that solved his problem with numbness and tingling in his leg from spinal stenosis.  He had a residual problem which he came to Spine Center Miami to be treated.  I placed him on some oral steroids and resolved the problem.  Even 6 months later he is 50% better and if he does the physical therapy prescribed he should do well.

 

Unfortunately he went to an academic institution in the area and they immediately recommended an anterior cervical fusion and discectomy for spinal stenosis.  This was an MRI based only diagnosis.  In other words age related narrowing of the cervical spine on the MRI is seen a high percentage of the time.  The decision to recommend a surgery has to do with significant myelopathy.  In other words, someone has weakness in the legs, a wide-based gate, they can’t stand up, their balance is off, and ultimately they have weakness to the point where they have trouble going up and down stairs.  It also effects the upper extremities to where you have numbness and tingling and they start dropping things. The patient may even have bowel and bladder problems.  These are significant findings.

 

This patient went to a very well known academic institution in the South Florida area.  Then he went to very well known academic institution in New York to see a very well known orthopedic spine surgeon who recommended and agreed that the surgery needed to be done.  Finally he returned to the same academic institution in South Florida and ended up having the surgery scheduled.  Fortunately, I was able to hear about this and spoke to him the day before the scheduled surgery and told he did not need surgery.  It’s been 6 months since he cancelled the surgery and the patient has never had a problem.  He has no neurological deficits related to his neck at all and it would have been an unnecessary surgery.

 

The surgery would have caused significant disability, significant pain, significant rehabilitation problems in an individual who is 70 years of age and did not need a surgical insult to him.  It’s sad that the doctors that are employed by the hospital, recommend surgery to justify their income stream.  This is a BIG CHANGE in the academic institution, both of which these were in New York and South Florida to justify a salary.  It’s a very sad case when this happens to a patient and I had not intercepted it, he may have been a disabled individual for the rest of his life.

 

In other words, don’t fix it if it’s not broken!