This is for Mr. Rosenthal in particular.
The two broad indications for spine surgery are: 1)Progressive neurologic deficit, such as bowel/bladder incontinence from a disk or tumor putting pressure on the spinal cord, or significant muscular atrophy of a limb because of the nerve roots from the spine being compressed. Thankfully this category is infinitely less common, and is usually associated with something catastrophic such as a tumor, or a highly traumatic injury from a football game or automobile accident.
The 2nd category is Intractible Pain. This is the category that most cases fall into. The overriding question is: How painful is too painful?! Unfortunately, spine surgery outcomes have been far from reliable. Even the best of neurosurgeons will tell a patient that if they are in this category of intractible pain, that they should avoid surgery if the pain is at all manageable. Where the concept of TMS comes in is that once you've established that a condition is not life-threatening, then you're left with such common diagnoses as "disk herniation," "radiculopathy (pinched nerve)," "facet syndrome," "mechanical low back pain," etc. By understanding TMS you would realize that these non-life-threatening diagnoses, which make up the majority of chronic low back pain disorders, are not to be feared. And the pain that accompanies them is simply that...pain. And pain does not in and of itself signify injury. The old school taught us that one must correct the anatomical abnormality associated with these disorders, with surgery, or physical therapy, or injections, or medications, or manipulation, or...whatever. The new school of TMS tells us that we don't need to fret over blips on an MRI, because it's the fretting itself that is causing the pain to continue and to worsen. Perhaps there is an element of validation that one seeks as a chronic pain patient who wants to be taken "seriously." Well, plenty of doctors will be glad to shower these patients with attention, in the form of a scalpel, or a syringe, or an adjustment, with sketchy results. But in the end, one must decide whether to choose validation, or emancipation. Attention to one's complaints, or freedom from pain. All of us here on this board are trying to make that choice clearer.
Parvez Fatteh, M.D. |
The indications for spine surgery.
Posted - 12/05/2004 : 02:13:23
