The most persistent problem I encounter is not nerve pain or slipped discs. It’s the tenacious misconception that someone can be “too old” for spine surgery when it’s truly needed.
Many years ago, it was true that age played a significant factor in a person’s ability to tolerate and recover from surgery. Surgeries were once highly invasive, and recovery could take months. But over the decades, spinal surgery techniques have improved to the point that many of the octogenarians I operate on leave the hospital the day of their surgery to begin a pain-free life.
Minimally invasive procedures require just a tiny incision in the back, preserving muscle and tissue and reducing bleeding and the risk of infection. The use of a surgical microscope allows the same visibility our surgeons have in an open surgery, but with minimal collateral damage.
Today, age means nothing when it comes to surgery. Deciding on whether spine surgery is necessary is the first key step, and surgery is only a consideration in the minority of cases when conservative methods have failed. A person’s medical history and co-morbidities, and a careful neurological evaluation are key in determining whether a person is a candidate for a surgical procedure. Unfortunately, a persistent, ageist misconception keeps too many older adults living with preventable pain and disruption to their quality of life.
What’s worse is that many of the people perpetuating this misconception are doctors themselves. Too many times, we have operated on patients in their 80s and 90s who told me they were talked out of surgery in the past by their primary care physicians. These doctors were content to supply their patients with repetitive prescriptions of narcotics to ride out the rest of their lives in pain.
When these patients came in for a second opinion, they found they could regain their quality of life, flush those pain pills, and regain their independence.
Of course, surgery isn’t right for everyone. With any medical condition, the most important thing to understand is the diagnosis. If someone comes to me with a chronic condition, it’s possible that their spine might not be the problem. Perhaps they’ve had a stroke, or maybe the issue is with their hip. I’m proud to say that most patients with spine problems don’t need spinal surgery, and we are always happy to refer them to appropriate specialists who can help them with more conservative measures.
Quite often, non-surgical options can help patients get better. Sometimes it can even be a matter of losing weight and exercising or receiving targeted physical therapy – no medications or surgery necessary. But it is unlikely for any treatment option to work unless an expert physician understands the underlying diagnosis. A good doctor knows what to do and when to do it. A great doctor knows what not to do and when not to do it.
If surgery is the right treatment for a patient’s diagnosis, we utilize advanced 3-D virtual-reality tools to help the patient visualize the targeted problem in their back. It also makes sense to get multiple opinions and select the surgeon they trust to create a customized approach for them. A surgeon who is committed to finding the best option for their patient will achieve better outcomes. One metric of quality to look for is known as “length of stay.”
Our patients average a one-day stay after surgery. The national average is four days. One reason for our success is our team approach. I rely heavily on a great team of colleagues, with case discussions, nurses, technicians, and more. When a team works well together, it shows in the quality of care.
Another factor to consider is a surgeon’s skill level with minimally invasive procedures and with advanced equipment. Ask him or her, “What are the top 10 surgeries you perform on a regular basis?” If your planned surgery is not one of them, find someone who has more expertise. Surgery is not an option for everyone; it is not the right course of action for all diagnoses, and not every spine surgeon has the same skill set.
But when it comes to determining whether a patient should be able to seek a better quality of life, age has nothing to do with it.
Burak Ozgur is a neurosurgeon and chief of service, neurosurgical spine program, Hoag Memorial Hospital Presbyterian, Newport Beach, CA.
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