You're a candidate for spinal surgery. What questions should you ask prior to surgery.
Dr. Scott Boden, Chairman Department of Orthopaedics, Professor of Orthopaedic Surgery at Emory University School of Medicine, Director of Emory Orthopaedics & Spine Center, and Chief Medical Officer/Chief Quality Officer Emory University Orthopaedics & Spine Hospital, discusses what you need to find out before spine surgery.
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Questions to Ask Before Spine Surgery
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Learn more about Scott Boden, MD
Scott Boden, MD
Scott Boden, MD started practicing at Emory in 1992. During his spine fellowship at Case Western Reserve Hospital in Cleveland, Dr. Boden trained with one of the founding fathers of modern spine surgery, Dr. Henry Bohlman. A primary original researcher on bone growth factor development and spine fusion technology, Dr. Boden is also an internationally renowned lecturer and teacher and the driving force behind the Emory Orthopedics and Spine Hospital (EUOSH). He has received numerous research grants, research awards, is consistently named as one of America’s Top Doctors, and was recently designated as one of the 100 Top Spine Surgeons in the U.S. (Beckers).Learn more about Scott Boden, MD
Transcription:
Bill Klaproth (Host): You are going in for spine surgery. What questions should you be asking? Here to answer that question and more is Dr. Scott Boden, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopedics and Spine Center at Emory Healthcare. Dr. Boden thank you for your time. So, asking questions before surgery has immense value to the patient and I imagine the surgeon as well as it helps to have a well-informed patient. Is that correct?
Scott Boden, MD (Guest): Absolutely helps to make sure that there are realistic expectations and to confirm that surgery is the right next step for a patient. A lot of times people just assume or were told somewhere that that’s what they should be doing; but it’s really important to actually make sure that you are at the point where surgery is the best next step.
Host: So, when surgery is the next best step and it’s going to happen, let’s talk about questions to ask. Pre-surgery, what should they be asking you?
Dr. Boden: Well an important question is, what is the likelihood that this procedure is going to help my problem? And similarly, it’s really important to make sure that the surgeon understands what your most bothersome symptoms are. A lot of times people have some combination of back pain and leg pain or neck pain and arm pain; but actually, going into detail about which is the more bothersome symptom can often better match the planned surgery and a likely good outcome.
Host: So, you are setting that expectation right up front then? Is that correct? So, the person really understands this is the right procedure to take care of my bothersome symptoms.
Dr. Boden: Absolutely. And there are some problems that spine surgery 97% of the time is going to be able to solve extremely well. There are other situations where it’s not a sure thing. And in those cases, usually surgery is the last option not the first option. But it’s really important to get a sense of what’s the likelihood of success.
Host: Yeah, that’s really important. So, when it comes to the surgery itself, what questions should someone be asking you?
Dr. Boden: Well I think that the first basic thing is to make sure you understand what’s being done in simple terms. And usually that is some combination of either unpinching nerves or stabilizing the spine and it could be one or the other or both of those. But most every spine operation is usually doing one or both of those things.
Host: So, unpinching nerves and stabilizing the spine. So, make sure that you understand that. What about recovery and after surgery?
Dr. Boden: Yeah, and with some spine surgeries you are going to be up and walking and walk out of the operating room as an outpatient surgery or almost Band-Aid surgery and in other cases, you may be in the hospital three to five days, maybe in significant restrictions from bending, twisting or any heavy lifting for variable periods of time after the surgery ranging from weeks to months. So, depending on what kind of work you do and your activities; it’s really important to understand what your activity restrictions are going to be immediately after surgery and how long they are likely to be in effect.
Host: Yeah, I can see where that’s really important and especially when it comes to the back, you said this could be several weeks if not more and maybe asking the question; am I going to be able to care for myself or will I need help. I mean those are probably good questions to ask as well?
Dr. Boden: Yeah, that’s a very common question along with am I going to be able to go up and down stairs. And in most cases, if people are able to do those things before the surgery; they are probably going to be able to do them afterwards and certainly within a week or so after surgery. But people who have significant either weakness or other problems or mobility constraints before surgery; they may not instantly be normal after surgery and they are more likely going to need some help in the period immediately following the procedure.
Host: So, spine surgery can be nerve wracking just thinking about that and very delicate areas you are working in. What about risks and complications? What questions should people be asking you to fully understand what’s happening?
Dr. Boden: The interesting thing about spine surgery is everyone always worries about what are the chances I might get paralyzed or something like that. And that’s almost as unlikely as being hit by lightning. Meaning we know it happens. Most of us have never seen it happen ourselves. But we know it happens every now and then and if it does it’s a big problem. And so, the more common risks and complications in spine surgery are related to anesthesia; going to sleep and waking up. Things like blood clots, heart attack, strokes in older people. It’s not the things that people most often worry about which is related to spine and nerve function.
Host: Well that’s really good to know because I think that is the overwhelming perception. Oh my gosh, they are operating on my spine for my lower back problems or my neck problems. Oh my gosh, am I going to get paralyzed. So, as a person that suffers from back problems Dr. Boden, I am very happy to hear you say that. Okay, so how about follow up visits and long-term prognosis? What kind of questions should people be asking you about that?
Dr. Boden: Yeah, I mean it’s important to know how often you are going to need to be followed up. For some things it may be one post-op visit a few weeks after surgery and then one check at a year. For other things it may be more frequently if you are monitoring the progress of bone healing or wanting to make sure that metal screws or cages are staying in place while the body heals bone if it’s a case of a fusion. So, it really depends on the operation and so, everyone has to ask that question unique to their situation.
Host: And how about medications after surgery, even prior to surgery? What should people be asking about that?
Dr. Boden: Well any medication that is going to cause an increased risk of bleeding or affect blood clotting like blood thinners, anti-inflammatories and a number of other medications that have that affect are usually needing to be stopped prior to surgery and delayed in terms of restarting after surgery. The other thing is some of the arthritis medicines, the anti-inflammatories can affect bone healing and so in somebody that is having a bone fusion; some surgeons will want them to stay away from those medicines that could affect bone healing for several months after surgery.
Host: Dr. Boden I’m just thinking about this. I know you do get a lot of questions, but do you ever say to yourself boy everybody asks me this question, what they should be asking me is this question. What would that question be that people should ask you, but they don’t?
Dr. Boden: Well I think there are probably two questions. One is do I really need to have this surgery. Sometimes people get told they have to have surgery when it’s really in most cases in spine it’s an elective decision and it’s a matter of the patient balancing how much the impact it’s having on their daily activities and function versus what they would want their situation to be. A lot of people unfortunately, look at MRI scans and carry these diagnoses with them and immediately sort of go down the path of surgery. But it’s really important to make sure you ask the surgeon and ask yourself, do I really need to have this surgery and do I need to have it now. And so, that should be a conversation that hopefully a potential surgeon could guide you through if you were a patient.
The other way to start to get at that is what happens if I don’t have this surgery now. Sometimes people are told that they have to have a surgery, or they are scared into it because they might get paralyzed and that’s extremely rare and extremely unlikely. So, it’s important to get a second opinion if somebody is telling you that and really just to make sure that you’ve considered all of the viable options to surgery and that the likelihood of success of surgery relieving the symptoms that you are most concerned about is high and the risks and complications are low. That’s the ideal situation if you are contemplating surgery.
Host: I love that answer. Those are two great questions to ask. Do I really need this surgery and what happens if I don’t have this surgery? That is excellent Dr. Boden. And if you could wrap it up for us. What other question should you be asking your surgeon?
Dr. Boden: I would say probably the most important question would be have you ever done this before.
Host: That would be a good question. That would be good to know, right? If this is your first time or your 958th surgery. That would be a good question to ask.
Dr. Boden: You don’t want to be the first or the last.
Host: Very good. You want to be in there somewhere, right. Right in the primetime. Alright, Dr. Boden well thank you so much for your time today. We appreciate it and for more information please visit www.emoryhealthcare.org/spine, that’s www.emoryhealthcare.org/spine. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): You are going in for spine surgery. What questions should you be asking? Here to answer that question and more is Dr. Scott Boden, Professor of Orthopedic Surgery at Emory University School of Medicine and Director of the Emory Orthopedics and Spine Center at Emory Healthcare. Dr. Boden thank you for your time. So, asking questions before surgery has immense value to the patient and I imagine the surgeon as well as it helps to have a well-informed patient. Is that correct?
Scott Boden, MD (Guest): Absolutely helps to make sure that there are realistic expectations and to confirm that surgery is the right next step for a patient. A lot of times people just assume or were told somewhere that that’s what they should be doing; but it’s really important to actually make sure that you are at the point where surgery is the best next step.
Host: So, when surgery is the next best step and it’s going to happen, let’s talk about questions to ask. Pre-surgery, what should they be asking you?
Dr. Boden: Well an important question is, what is the likelihood that this procedure is going to help my problem? And similarly, it’s really important to make sure that the surgeon understands what your most bothersome symptoms are. A lot of times people have some combination of back pain and leg pain or neck pain and arm pain; but actually, going into detail about which is the more bothersome symptom can often better match the planned surgery and a likely good outcome.
Host: So, you are setting that expectation right up front then? Is that correct? So, the person really understands this is the right procedure to take care of my bothersome symptoms.
Dr. Boden: Absolutely. And there are some problems that spine surgery 97% of the time is going to be able to solve extremely well. There are other situations where it’s not a sure thing. And in those cases, usually surgery is the last option not the first option. But it’s really important to get a sense of what’s the likelihood of success.
Host: Yeah, that’s really important. So, when it comes to the surgery itself, what questions should someone be asking you?
Dr. Boden: Well I think that the first basic thing is to make sure you understand what’s being done in simple terms. And usually that is some combination of either unpinching nerves or stabilizing the spine and it could be one or the other or both of those. But most every spine operation is usually doing one or both of those things.
Host: So, unpinching nerves and stabilizing the spine. So, make sure that you understand that. What about recovery and after surgery?
Dr. Boden: Yeah, and with some spine surgeries you are going to be up and walking and walk out of the operating room as an outpatient surgery or almost Band-Aid surgery and in other cases, you may be in the hospital three to five days, maybe in significant restrictions from bending, twisting or any heavy lifting for variable periods of time after the surgery ranging from weeks to months. So, depending on what kind of work you do and your activities; it’s really important to understand what your activity restrictions are going to be immediately after surgery and how long they are likely to be in effect.
Host: Yeah, I can see where that’s really important and especially when it comes to the back, you said this could be several weeks if not more and maybe asking the question; am I going to be able to care for myself or will I need help. I mean those are probably good questions to ask as well?
Dr. Boden: Yeah, that’s a very common question along with am I going to be able to go up and down stairs. And in most cases, if people are able to do those things before the surgery; they are probably going to be able to do them afterwards and certainly within a week or so after surgery. But people who have significant either weakness or other problems or mobility constraints before surgery; they may not instantly be normal after surgery and they are more likely going to need some help in the period immediately following the procedure.
Host: So, spine surgery can be nerve wracking just thinking about that and very delicate areas you are working in. What about risks and complications? What questions should people be asking you to fully understand what’s happening?
Dr. Boden: The interesting thing about spine surgery is everyone always worries about what are the chances I might get paralyzed or something like that. And that’s almost as unlikely as being hit by lightning. Meaning we know it happens. Most of us have never seen it happen ourselves. But we know it happens every now and then and if it does it’s a big problem. And so, the more common risks and complications in spine surgery are related to anesthesia; going to sleep and waking up. Things like blood clots, heart attack, strokes in older people. It’s not the things that people most often worry about which is related to spine and nerve function.
Host: Well that’s really good to know because I think that is the overwhelming perception. Oh my gosh, they are operating on my spine for my lower back problems or my neck problems. Oh my gosh, am I going to get paralyzed. So, as a person that suffers from back problems Dr. Boden, I am very happy to hear you say that. Okay, so how about follow up visits and long-term prognosis? What kind of questions should people be asking you about that?
Dr. Boden: Yeah, I mean it’s important to know how often you are going to need to be followed up. For some things it may be one post-op visit a few weeks after surgery and then one check at a year. For other things it may be more frequently if you are monitoring the progress of bone healing or wanting to make sure that metal screws or cages are staying in place while the body heals bone if it’s a case of a fusion. So, it really depends on the operation and so, everyone has to ask that question unique to their situation.
Host: And how about medications after surgery, even prior to surgery? What should people be asking about that?
Dr. Boden: Well any medication that is going to cause an increased risk of bleeding or affect blood clotting like blood thinners, anti-inflammatories and a number of other medications that have that affect are usually needing to be stopped prior to surgery and delayed in terms of restarting after surgery. The other thing is some of the arthritis medicines, the anti-inflammatories can affect bone healing and so in somebody that is having a bone fusion; some surgeons will want them to stay away from those medicines that could affect bone healing for several months after surgery.
Host: Dr. Boden I’m just thinking about this. I know you do get a lot of questions, but do you ever say to yourself boy everybody asks me this question, what they should be asking me is this question. What would that question be that people should ask you, but they don’t?
Dr. Boden: Well I think there are probably two questions. One is do I really need to have this surgery. Sometimes people get told they have to have surgery when it’s really in most cases in spine it’s an elective decision and it’s a matter of the patient balancing how much the impact it’s having on their daily activities and function versus what they would want their situation to be. A lot of people unfortunately, look at MRI scans and carry these diagnoses with them and immediately sort of go down the path of surgery. But it’s really important to make sure you ask the surgeon and ask yourself, do I really need to have this surgery and do I need to have it now. And so, that should be a conversation that hopefully a potential surgeon could guide you through if you were a patient.
The other way to start to get at that is what happens if I don’t have this surgery now. Sometimes people are told that they have to have a surgery, or they are scared into it because they might get paralyzed and that’s extremely rare and extremely unlikely. So, it’s important to get a second opinion if somebody is telling you that and really just to make sure that you’ve considered all of the viable options to surgery and that the likelihood of success of surgery relieving the symptoms that you are most concerned about is high and the risks and complications are low. That’s the ideal situation if you are contemplating surgery.
Host: I love that answer. Those are two great questions to ask. Do I really need this surgery and what happens if I don’t have this surgery? That is excellent Dr. Boden. And if you could wrap it up for us. What other question should you be asking your surgeon?
Dr. Boden: I would say probably the most important question would be have you ever done this before.
Host: That would be a good question. That would be good to know, right? If this is your first time or your 958th surgery. That would be a good question to ask.
Dr. Boden: You don’t want to be the first or the last.
Host: Very good. You want to be in there somewhere, right. Right in the primetime. Alright, Dr. Boden well thank you so much for your time today. We appreciate it and for more information please visit www.emoryhealthcare.org/spine, that’s www.emoryhealthcare.org/spine. You’re listening to Advancing Your Health with Emory Healthcare. I’m Bill Klaproth. Thanks for listening.