Why You Should Get a Pain Management Opinion Before Spine Surgery
If you've been scheduled for back or neck surgery, I urge you to get a pain management consultation first. This isn't anti-surgeon advice — it's about ensuring you've explored all your options before undergoing a procedure with a 6–12 week recovery that carries real risks and doesn't always achieve the desired result.
The Statistics on Spine Surgery
The reality of spine surgery outcomes:
- 20–40% of lumbar fusion patients develop failed back surgery syndrome — persistent or new pain after surgery
- Adjacent segment disease is common after fusion, leading to further degeneration at neighboring levels
- Re-operation rates after initial spine surgery are significant
- Lumbar disc surgery for herniation has the best outcomes, but even here 5–10% of patients have persistent pain
I am not suggesting spine surgery is wrong or that surgeons don't have good intentions. For the right indication — progressive neurological deficits, spinal instability, cauda equina syndrome — surgery is absolutely appropriate and necessary.
But spine surgery is often recommended when the evidence for non-surgical treatment is equal or better.
Cases Where a Pain Management Opinion Changes the Picture
Lumbar disc herniation: For most patients without progressive neurological deficits, non-surgical management (epidural steroid injections + physical therapy) achieves equivalent outcomes to surgical discectomy at 12–24 months, with significantly lower risk.
Spinal stenosis: The MILD procedure, Vertiflex spacer, and Intracept procedure offer meaningful relief without fusion or open surgery for properly selected patients.
Facet pain: Medial branch blocks followed by radiofrequency ablation can provide 12–18 months of relief from the very pain being attributed to a "bad disc" — no surgery required.
CRPS and chronic radicular pain after prior surgery: Spinal cord stimulation, ketamine infusion, and other interventional approaches often achieve better results than reoperation.
What I Ask Patients
When a patient comes to me who has been scheduled for surgery, I ask:
- Is there a progressive neurological deficit that requires urgent surgical intervention?
- Has the specific pain generator been identified and confirmed diagnostically?
- Have appropriate non-surgical options been tried for an adequate duration?
- Have the risks of surgery been fully disclosed?
If the answer to 1 is no, 2 is uncertain, 3 is no, or 4 is unclear — there's value in a pain management consultation before proceeding.
Getting a Second Opinion
A second opinion before spine surgery is not an insult to your surgeon — it's due diligence. Most reasonable surgeons welcome it. Call 516-492-3100 to schedule a pre-surgical pain management consultation.