The value of “another” opinion for spinal surgery: A prospective 14-month study of one surgeon's experience

BACKGROUND: Neck or back problems are experienced at some time by many Americans and many patients receive recommendations for spinal surgery. Patients naturally seek another opinion to confirm the need for surgery, or for the particular procedure recommended. METHODS: Over approximately a 14-month period, the author prospectively collected data regarding 240 consecutive patients seeking a surgical opinion regarding a spine problem. Imaging studies were reviewed and patients were asked to comment on the consultation experience. RESULTS: Of the 240 patients, 155 (65%) came for a second, third, or fourth surgical opinion following an earlier opinion from a surgeon who recommended an operation. Of these patients, the author recommended no surgery for 69 (44.5%) patients. The remaining 85 (35%) were referred by primary care doctors or neurologists for initial surgical (first) opinions because of magnetic resonance imaging (MRI) or computed tomography (CT) reports indicating the presence of surgical lesions. The author recommended no surgery for 37 (43%) of these 85 patients. CONCLUSIONS: Patients request and deserve the attention of a physician who will listen to their history and perform a careful neurological examination. The results of the neurological examination and the imaging studies must then be carefully integrated and correlated with the patient's complaints. The results should be explained to the patient so that he or she will understand the surgical or non surgical nature of his or her problem.