It can be overwhelming, frightening, terrifying (insert your own adjective here) having back pain, leg pain, other more concerning or embarrassing neurologic symptoms, or more than one of these that would not get better with physical therapy, stretching, chiropractic manipulation or any of the other things “people say you should do.”  For those of us “in the business” it is also one of our big fears to miss a bigger problem in another part of the neural axis focusing on the symptoms the patient sees (the back pain, the leg pain) and does not recognize the more subtle but serious symptoms of a neurologic problem higher up in the nervous system.

What do I mean by that? Very often masked within the pain (and perhaps seasoned with a small amount of denial or lack of awareness that these can be separate issues) are balance problems, hand weakness or numbness or tingling or pain.  In other cases, unexplained, “weird” symptoms that a patient may be afraid will make them less likely to be taken seriously by a practitioner, such as brain fog, facial symptoms, neck pain, headaches may be debilitating.  These are not necessarily proof of a clear higher neurologic dysfunction, but they could be and therefore should be evaluated by someone who understands the complex interplay of the different components of the nervous system and that can cause symptoms like these.  “It’s my back that hurts doc, not my neck” is something I hear quite frequently.

Without understanding the anatomy and function of the rest of the neurologic system, I cannot dive deeper and be able to tell on a relative basis what the most important next step should be.  While every single procedure I undertake (even every test I order as that may delay implementation of another treatment) I am acutely aware in every single encounter I have with the patient, the risks, and benefits, not only of a surgical procedure, but the risks and benefits of proceeding down in particular line of inquiry into what is causing the symptoms that they are in the office to see me about.  It is not enough to just pick the right procedure based on the films that the patient comes in with, the art of spine surgery is knowing when those films and the history that they initially present with are not adequate to understand the whole picture of what’s going on with a patient.

I am not satisfied with doing “a pretty good job” and as a patient, you should not be satisfied when the spine surgeon you see books you for surgery and only spends five minutes with you to figure out what is really going on.  Why is this so important? “Because while common things happen commonly” is an aphorism among people who are looking to keep their diagnostic workup simple and efficient (taking more time with each patient means fewer patients can be seen in an hour).  However, each patient deserves that surgeon’s best effort, not their mediocre effort or at least, that is what I believe.  In this day and age that I may be one of the last people to feel that way but as they say in the Mandalorian, “this is the way.”