Why won’t the Surgeon Operate on my Spine?
There are legitimate reasons why a Surgeon will not offer elective spine surgery on patients.
Bear in mind, we are talking ELECTIVE SPINE SURGERY, not emergency surgery. As you know, elective surgery may definitely be warranted, as the patient has debilitating pain, or loss of function that does not improve with non surgical care. The surgeon, however, must match the complaints to the findings on diagnostic testing, and also gauge the patient expectation. If there are inconsistencies among those factors, the results may be an improvement after surgery, but unrealistic expectations will deem the surgery a failure, by the patient. Unfortunately, poor outcomes do happen. A prudent surgeon will do what he or she can to minimize these poor outcomes. Sometimes, that is by refusing surgery.
As a surgeon, my goal is to help patients with their surgical needs. In emergent situations, I am called to try to resolve a potentially limb or life threatening situation. While patient expectations are also important, in emergency situations, the pressing needs to save the situation is primary. In emergency situations, while the patient expectations and outcomes are important, equally important are the community expectations on treating emergent situations. Patients who refuse emergency operations are required to sign documents indicating refusal of emergent treatments Against Medical Advice.
As far as elective spine surgery goes, surgeons have the right to refuse surgical treatment if there is no emergency situation. As many patients think their situation as emergent (although medically, it is not), they question the refusal, and demand surgery. Often times, there are specific reasons surgery why will not be offered:
- Physical examination findings do not match the identified problem on diagnostic testing.
- Pain complaints do not seem consistent, or are out of proportion to the findings on testing.
- The identified condition is too diffuse, and successful surgical outcome is difficult to predict.
- The patient, and family may be unrealistic about the effects of surgery. As I like to say, ” if you are 60 years old, the surgery will return you back to being 60 years old. The surgery will not make you 20 again. “
- The patient may have comorbidities such as obesity, diabetes, or respiratory problems that will make the surgery likely to cause more problems than it will fix.
- There is a need of a much more complex surgical procedure, one that is not amenable for proper management in a private practice setting. Sometimes, the surgery is too large in scope. Certainly, the technical aspect can be performed by any competently trained surgeon. The aftercare, and monitoring necessary during and after surgery may not be available in all hospital settings. These surgeries may be better off in a Tertiary, or Teaching Hospital Environment.
- The technique desired by the patient is still experimental, with no proven track record. In the past, I was involved in FDA trials of new technologies. The “study patients” had tremendous guidance and followup. The prime objective was always the safety of the patient. If you want experimental treatment, please get enrolled in one of the studies. Use of experimental procedures, otherwise, has a fair amount of medical and financial risks. I do not perform any experimental surgeries any more. If you want this type of surgery, please look up studies in ClinicalTrials.gov. There are over 700 trials going on that are being monitored by the FDA. In my opinion, this is the safest way to participate in experimental spine surgical procedures.
In the end, surgeons decline to offer elective spine surgery because they cannot predict a good outcome, or the procedure desired is experimental. Frankly, it is my opinion that surgeons who refuse elective surgery are probably trying to do what is best for their patient. As you all know, you can always find someone to do your surgery. There is too much incentive for many surgeons to just go ahead and operate. If a surgeon says no, there must be a very good reason. Please take that into consideration and remember, you can always get a second opinion, but research your surgeons first.
Last modified: February 8, 2019
I have something called Transversemialitus a spine disease I’m told there is no surgery for this I’m in a wheel chair for 5 years now and would like to no if there’s any where I can get treatment
I underwent c3 – c6 laminectomy without fusion May 2022. Spinal stenosis with mild / moderate cord compression. Mild left foraminal stenosis noted at c4 – c5 not altered.
7 months later I am in severe pain with neurological deficits. My recent mri indicated multilevel bilateral moderate / severe foraminal stenosis. I have since moved away from my neurosurgeon. My new GP has sent referrals to two neurosurgeons, both have refused me for exam, stating the central stenosis has been adequately decomposed?
Why am I not offered the opportunity to explore foraminotomy surgery to decompress the numerous nerve roots?
What should I do as I have had back pain for over 6 months. I have had 4 injections and one radio frequency ablation all within this 6 months span. Recently I was in 2 car accidents that exacerbated my current injury. I have bulging discs at L1 L2 ,L4 L5. I also have degenerative disease at L1 L2 and L4 L5 and moderate arthritis at my l4 l5 facet joint I also have numbness and tingling that go down my right leg to my ankle and I get that drop foot syndrome. I see a chiropractor I also do physical therapy and a pain management center and they want to do another set of injections. I have had 2 MRIs one from a year ago and 1 recently a month ago. Still showing I have the 2 bulging discs and 2 degenerative discs. I have had 2 surgeons look at my case and they have both declined but would not give me a reason. I am frustrated to the point as I’m trying to get better and reasonable accommodations at work. It’s hard to live with this pain every day. Now because 2 surgeons have declined surgery should I worry about other surgeons declining the procedure. Any help would be appreciated but I feel that I keep going in circles and nothing seems to get fixed.
Your surgeon need to weigh the risks of surgery, as well as the likelihood of improvement after the surgery. Surgeons know all too well that any surgery cannot be 100% predicted for success and will decide on surgery only after weighing the risks, alternatives, and goals. Heroic efforts should be offered in life threatening situations. The need for most surgery is not that drastic. Please ask you surgeon why your surgery would be too risky, or less predictable in your situation.
my husband was told his disc was too far gone to replace. That doesn’t make sense to me. Is there a point that it’s too late to replace one?
That is possible. While the disc is in the front of the spine, there are joints in the back that need to be relatively normal if you are considering a disc replacement. Please discuss with your surgeon.
Hi my mri scan showed at the level of l5 s1 there is disc bulge with central protrusion indenting the sac . And there is Progressive of the right side exit foramina and invitation of l5 . I have severe lower back pain my surgeon said he won’t operate on me and has referred me to the chronic pain team . What would you suggest I do next please
I cannot give specific advise to anyone, but provide general comments. Most surgeons will assess a person to determine the need for surgery after weighing the risks and goals. If the surgeon does not see a predicted improvement of a situation, or considers the risks too great, then an operation would not be recommended. If you are dissatisfied with your surgeon’s opinions you can seek other opinions. But like people, surgeons also come in three general personalities, aggressive risk takers, moderate risk takers, and minimal risk takers. You will need to consider your own personality, and decide if your surgeon matches your own risk tolerance. Remember that risk means it may not turn out favorably.
I am 81 and female. Have had sciatica since age 30. Over the years my disks deteriorated. l 3, 4,5 and S1 all bad including faucets on 2. Osteoarthritis in lower disks. Scolitis, scoliosis. Nerve damage as narrowing of spinal column. Every day is painful. Feels like a sledge hammer hits my hip. One day is on right side, then switches. I can’t take nasaids, spinal injection only stopped pain for a few days then all came back. Recent MRI showed bad damage on disks but surgeon said she wouldn’t do surgery as it would require fusing all bad disks and I would be worse off, not be able to bend,etc. I don’t want pain pills for every day making me dizzy and nauseated. So what can I do with daily pain. I tried 5% lidocaine patches but Medicare won’t cover and I can’t afford the costs. Only way surgeon said she would do surgery is if my leg became totally numb and that would be an emergency. I don’t understand.
Sorry to hear you are doing so poorly. As a surgeon, I will tell you that risks must always be weighed, and risk also means a planned intervention (surgery) may make matters worse. Please discuss your concerns with your surgeon. There may be a risk that needs further discussion so you can understand the reason for not suggesting surgery at this time.
I just got done seeing spine surgeon he pretty much said the same thing as your video above I’m not a good candidate so I guess I’ll have to try other alternatives like Rolfing or something else let me know if you have any suggestions
I have spondylolisthesis DDD sciatica and spinal stenosis and scoliosis
thanks
Joe
I was homeless on and off for 6 years in Toronto. I’ve been in 4-5 car accidents, and slept on the freezing concrete for weeks at times. I am currently sober, for 5 years and in a good position in life. My pain is a consistent 10. I just got custody back of both of my little girls, 12 and 4. I am currently raising them regardless of the pain I endure. It’s still a 10, some days I can’t even move while in bed. Doctors have refused any opioid meds, and NSAIDS are not helping. I have a slipped disc in each; L4,S1, and S2… Surgeon declined surgery. I can’t raise my kids in this much pain… am I expecting too much to get a second opinion, and surgery?
You can always get a second opinion. Surgeons do not recommend surgery casually. If the Surgeon has concerns that the outcome will not be beneficial, or the risks are too large, or the expectations not obtainable, then the lower risk alternative is to recommend against surgery. I have empathy for you. As a surgeon, I also know that sometimes, surgery cannot solve the problem.
Dr. Shim, I am a 47-yo female diagnosed with these terms: lumbar degenerative disc disease, spinal stenosis, bulging discs, spondylosis, SI joint dysfunction, sciatica, spinal bone spur, ostheoarthritis, and arthritis. A well-respected neurosurgeon said I need 2 new discs, which basically is impossible to fix. What I remember so much about the consultation was she kept repeating “I cannot operate on you because of your age…age under 50.” How do I interpret this? I am living in pain daily and always it’s so severe that I would do anything—even if I have to wear a rod on back to get pain relief.
IF you are not confident in the opinion, please get another one. At the same time, know that most surgeons will not recommend surgery if there are non surgical alternatives, or if the potential for success is not great, or if the goal of the patient is not obtainable by surgery.
I was a passenger in a corvette and my head cracked windshield and my sinus cavity orbital socket and a cpl. More fractures also I have a ruptured
disc. The disc is sticking out and is on my nerve. But the surgeon felt I was not a candidate because of my brain injury I also suffered from a mini stroke 3 yrs later had a P .E. . I am in pain but they say I have to much going on and feels Anastasia and the risk of blood clots she had to take in concentration. Is this the best outcome or do I need to see another surgeon.
Every surgery has risks. The worst risk may not be that you die, but you have a terrible stroke, or some other condition that will cause you a permanent long term devastating issue. While many people will say they are willing to take the risk, the burden will be on everyone, not just you. The surgeon may know the risks of this outcome is high so that makes you a very poor candidate. I will put this delicately. You can always find a surgeon who will do your surgery, no matter the risk. The question you should ask is Would your Surgeon also take that same risk for themselves, or their loved ones?
So sorry this is long: I’m 54 & have the L5 S1 disc bulge (is term on MRI report) Have had problems w it for several yrs. When it was explained to me, I went on w physical therapy, the conservative treatments prescribed. It always was effective & even as I aged & the flares got a ltl worse, took a ltl longer to start feeling better, I always did feel better & knew from experience that it would calm down & go back to the usual pain that was there so often. Almost 2 yrs ago, something different happened. Sudden extreme pain in my hip, totally different than anything before. It was like a spear shot from the outside just under the hip where the side of the glute begins through to my pelvis. I started going down, seemed like hip kind of snapped. Luckily was at the kitchen counter, knew I was going to fall so threw my upper body forward across the counter, getting weight off my legs,stayed there groaning & writhing for 20, 30 minutes. It didn’t let up. I never thought it was broken, thought maybe the problem disc had “blown” . Didn’t know if that was a thing but it’s what went through my mind. I knew I had to lie down so chanced it & put weight on it, grabbed ice pack & limped in pure agony about 15 feet to the couch. I started doing the usual ice, nsaids, etc. Still no relief at all. 2 yrs later, I am barely functioning, glute muscle fell or something, had EMG that said something about denervation at calf,( my term,). I don’t know why the string of Drs, phys therapists, chiro Dr, won’t order different imaging, listen to me that the new MRI of lumbar hasn’t changed very much since the one I got 6 yrs ago, that this is totally different & it doesn’t make sense how this is affecting me, taking me down, swallowing up my life. I certainly wouldn’t be practically begging for surgery to release whatever is trapped up in there. Especially since I’ll get just 3 days of pain control even after surgery. I don’t care, that’s how bad the pain is. For the love of God, why are the Drs I see just passing around the same lumbar MRI, won’t investigate further, telling me I have mild arthritis. I’ve known that for yrs. This is all in the hip & pelvis and there is nothing mild about it, Moving that area when I wake up starts the downward spiral into high levels of pain daily. What is going on? Is my theory that different imaging needs taken wrong? Does it not make sense that there’s something else going on if I’m not getting better w anything?
I’m sorry we can not give advice for a specific problem without seeing the patient.
Hello I’ve been suffering from a bad herniated disc in my lower back it is causing station in my leg and private areas to go away or to just hurt even with material touching my skin I have now been like this seven months I also suffer from facet joint syndrome and osteoarthritis in my hips I am 36 years old and I’ve been off work and cannot even find a new job until I am able to get rid of some of this pain my doctor has refused surgery but told me it is possible
I’m sorry we can not give advice for a specific problem without seeing the patient. Please get a second opinion.
I was told 2 years ago by a neurosurgeon that he would operate on my lower spine sue to 2 protruding discs. He then went on to say he would have to operate on my c3 and c4 first due to the positioning they would have to put me into for back surgery could cause me paralysis. I agreed to the neck surgery which went well . I then saw the neurosurgeon again who stated he wanted an up to date mri scan b4 he went ahead with my lower back surgery. I cried with relief onky for the next appointment for him to tell me that as I wasn’t particularly suffering in my legs then he wouldn’t operate just for a bad back. And opinion came and this time the consultant didn’t even look at my up to date mri scan before stating he was not going to operate and whwn I asked what I should do now, he states, I don’t know. He says that back surgery on protruding discs doesn’t work. I am devastated as I have slipped a disc 4 times now and it is constantly on the verge of slipping every day. I take Morphine for the pain… amongst many other medications and I cannot work. I am only 42 years of age. Please can someone help me?
You should get another opinion and have someone actually explain what is happening with your back when you “slip a disc”. Not knowing you or seeing your films, we cannot tell you exactly what is going on. As a special note, very often many back surgeries are very helpful for leg pain but not so much for straight back pain. Good luck to you.
The disc level at C7T1 and decompression of the C8 nerve root is a difficult surgical fix . A fusion there can lead to problems in the upper thoracic spine. I also had a C7T1 disc herniation with foraminal narrowing. It took 3 years , but it did start to finally improve with physical therapy, good posture and the use of a stand up desk. If I stand at the computer too long, I will still occasionally get a flair of a tight pulling kind of pain under my arm and or into the pinky finger side of my hand. Hang in there!
So many surgeries can be avoided with proper posture and therapy. Thank you for sharing!
My name is Walt Sanders…and I have numerous issues with my Cervical Spine. I had a C3-C4 Anterior Discectomy to remove Ruptured Disc from Spinal Cord in 2012. Then followed up with Posterior C3-C5 Laminectomy with Instrumentation in 2013.I also have Kyphosis…C5-C6 is now Fusing on it’s own. I am having Major Pain between my Shoulder Blades, in my Armpit, through my Right Tricep, down to my Pinkie Finger. I’m on Disability, but try to Work 20 Hours per Week. The Pain is Unbearable…with a CT Scan Showing narrowing Foraminal Space at C7-T1. I’m 52, and both NeuroSurgeons I saw Refuse to do Surgery. I Really need Help!