Decision-making in Spine Care

Spine X-ray

Neck pain and back pain are the two most common problems that plague Americans in their lifetime. It is estimated that 80 to 90% of the American population will suffer from neck or back pain in their lifetime that limits them in regards to their work or avocational activities.

The challenge comes in how do we address these issues and what options are available for spine care.

The treatment of back and neck problems is a very complex one, primarily due to the fact that we are all individuals and we all have very specific needs on a daily basis. Despite the amazing technology that now exits and the numerous options for treatment, there are still many concerns regarding spinal problems regarding the appropriate care and particularly for the decision as to whether one should have spine surgery.

My background, training and experience has provided me a basis to develop a consistent method for evaluating and treating these issues. Remembering that we are all different,

the plan involves the following:

  1. The history - how did the problem begin and how have the symptoms changed over time.
  2. The symptoms – are they consistent with the history? Are they consistently improving? Are they worsening? What makes them change?
  3. The physical exam - does it support the history and the symptoms?
  4. Diagnostic testing - does the actual anatomy correlate with the history and the symptoms and the physical exam?
  5. What is the natural history of the symptoms, should they agree with the anatomy and the exam, and what treatment options are available for this process?
  6. If considering surgery, have all of the nonsurgical options been tried and/or attempted, were they temporarily successful or not at all, and is there a safe and effective procedure for this particular problem for the individual patient?
  7. Are there specific factors regarding this particular patient, health issues, prior surgery, or other risk factors that need to be considered in determining treatment options and/or surgical intervention?

Taking all of these issues into consideration, one must remember that approximately 80% of all spine problems that do not have functional disability or loss of muscle function, do get well on their own over time. The treatment for each patient is designed for each individual with a , minimally invasive approach, particularly in regard to surgery. Surgical procedures are designed based on all of the prior treatment responses and diagnostic studies in order to correct the symptomatic anatomy and restore our previous function in the most effective manner with a minimal risk.

My goal is to always provide and explain the diagnosis, discuss the treatment options, particularly the risk and benefits and potential side effects, explain any and all testing and what it means in the face of one's symptoms, history, and exam, offer appropriate medications or other treatments if available and appropriate. I always encourage a second opinion, and the patient should always feel informed and comfortable in their decision making prior any irreversible course of treatment.

The goal of all medical care is to provide treatment which is effective and safe and offers the best value for pain relief, improved function and cost both of money and time invested.

Author
Steven C. Dennis, MD

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