A San Diego Spinal Surgeon's Plea For Less Surgery

If you have ever experienced back pain you are in good company. Most Americans have experienced back pain at some time in their lives. Surgery is one option. Our guest is convinced that in most cases that it is not the best option. Doctor Kamshad Raiszadeh is an orthopedic surgeon so he knows what I can do. He's also the medical director of advanced spine Institute and minimally invasive spine center and cofounder of's find soon clinics. You have also written a new book called take back control which you help will add to the national debate on the best ways to treat back pain. Is there a specific incident in your career at me to question whether back surgery was the best option? It was a cumulative understanding of a time where I was seen increasingly difficult problems with treating this population of patients who were seeking a way out of chronic back pain and increasingly looking at surgical solutions. I was stuck in a position of managing these patients and not having a good way of analyzing whether all the correct steps have been done preoperatively. As the final decision-maker and that type of position I felt inadequate and at times in deciding and accepting that everything had been done on operatively. So you end up making a decision to do surgery we feel like maybe there were other options and that's what led to increasingly being more informed and taken an interest in the nonoperative side and systemizing that. There are some back problems that do require surgery. Perhaps you can be specific about what might be a clear indication for surgery and what might not. This is where I started my practice. There was a sub portion of patients who need surgery for a nerve being severely pinched where they are paralyzed -- either partially or getting an increasingly progressive neurological tests of -- deficit. Or there's a deformity or a fracture or a tumor these need surgery and its well-defined and patients do very well. It's a whole spectrum of people who are something less well-defined. That's a much bigger population. Like you said 80% of the population has some -- some element of back pain but 10 to 20% develop chronic back pain and seek other types of treatment. The New York Times recently reported that research has rent studies on spinal fusion surgeries which were quite popular and they found that surgery was no better than treatments like supervised exercise but spinal fusion rates increased until some insurers said that they did not want to cover anymore. Why was surgery still so popular even after surgeons found out it was not working that well. It is because there is no great solution for this population. You have this population -- I see this all the time in my clinics. They say I have tried everything. I have been doing this for two and half years and I've tried acupuncture chiropractic physical therapy and my MRI scan shows a problem. So this is a very enticing condition for a surgeon who wants to help somebody and has a 12. Is that something that you want to show up on the MRI isn't necessarily going to be an accurate way of diagnosing a problem. This has been well studied. Absolutely not there are a means and completely asymptomatic places for 60 to 70% of patients at the age of 50. If you have this many patients with abnormal findings we should not be relying just on that. What questions should people with back pain be asking the doctor. I really think that a patient with chronic back pain half's -- has to use this in forged meeting out of this really understanding the condition and taken the time to realize that if they understand their anatomy and what mechanical causes could be contributing to their pain and understanding their psychological overlay and conditions that could be contributing to their sense of desperation for their pain also if they are at the point of needing surgery or considering surgery really understanding the risks and benefits and what would happen if they did not do surgery versus what are the reasonable expectations. This is where people were more understanding of the condition and asked the right questions a lot of them would realize that surgery is not the right choice. I want you to talk about what are some of the options you have come to believe are more effective. I think a more medically supervised exercise program and this is where I have devoted my time and energy to having been shown to be the best and easiest way to treat these kind of conditions because you are empowering your own body. You need to have control of your condition. To have control of your own condition you cannot have that of somebody else's either manipulated you are having to be there to treat you. Have to be there to understand your own body and increasing your own strength and your own body's ability to heal these conditions will resolve most of them. What we say about the time it takes because people want a quick fix. These -- are these alternative methods quick fix this? Anything that is a quick fix will not last. You need to devote the time and energy to understanding and doing the exercises and to letting your body heal. Soft tissue injury can take months to heal. You cannot think that there is a quick fix. Walk in is excellent biomechanically it puts little stress on your back and increases the endorphins by getting out there -- kind of lubricating mechanisms of the desk to bring nutrition to it. Your book has a lot of good suggestions and I will just say again it is called take back control. Thank you for coming in a given us an alternative perspective. This is Doctor Kamshad Raiszadeh who was a founder of spines on clinics.