Patients and physicians are not making logical or reasonable decisions regarding spine surgery. I have watched this phenomenon for almost 30 years and it is getting much worse. You have to be fairly intelligent to make it through medical school. A basic concept in trying to repair anything in the mechanical realm is that you have to identify the specific problem before you can fix it. The same holds true in your body except you have the added dimension of pain. Somehow this premise is not sinking in with a lot of surgeons. In order to feel pain a pain impulse must exceed the pain threshold. It does not matter if the impulse arises from inflammation, a bone spur or a prior pain pathway that has been stimulated. However the only scenario that surgery is a possible option is if you can identify the anatomical abnormality that is causing matching symptoms. Sciatica Without a Cause I recently was on the phone with a gentleman who had been experiencing pain down the side of his leg for almost a year. It was in the distribution of the 5th lumber nerve root. I was quite sure there was a surgical solution because the symptoms were so classic. I ordered a myelogram followed by a CAT scan of his lumbar spine. The test involves injecting an iodine-based dye into the dural sac, which contains the cerebrospinal fluid that bathes the spinal cord and nerve roots. It is very sensitive in that it allows us to see the flow of the dye and even the slightest nerve compression will show up. His test was completely normal. I gave him my book and website and explained that it outlined a framework of care for him to organize his own path to healing. Since he was from another state I was going to try to help him access some of his local resources after he learned the treatment model. I called him a few days ago. He told me that he had already done “pain management”. He had decided to undergo surgery that a local surgeon had offered him. He had not looked at any of the suggested tools that stimulate the brain to change and shift onto non-painful pathways. “Phantom Surgery” Think about this carefully. Why was a surgeon offering to perform surgery when he could not identify a problem? There is not a shred of evidence that says that this is a good idea. None. If the surgeon had offered this option while sitting for his oral board examination for neurosurgery he would have been automatically flunked for giving a dangerous answer. Second, it has been demonstrated in multiple research studies that any uncomplicated surgical procedure can induce chronic pain as a complication of the procedure. These are surgeries performed for straightforward problems such as hernia repairs or gallbladder removals. The risk is as high as 40% for having unrelenting pain for up to a year and 5-10% of the time it is permanent. I don’t believe I have ever heard a surgeon mention this possibility as a complication. The risk factors include depression, anxiety, and pre-existing chronic pain. The chances of making him worse are higher than making him better. Third, why should he take the word of one surgeon who gets paid well to perform surgery without really checking this out in depth? A large part of my practice is spent performing surgery to salvage prior surgery. In the majority of the cases the original operation should not have been done. He is headed down this same path. Why is it OK for the medical profession to offer him an operation without any basis? Fourth, surgery always carries risks – even the simplest of them. I will never forget the story of an airline pilot who had cut a tendon in his finger with a wine opener. An anesthetic technique was used that numbs up the entire arm. The tourniquet broke that was intended to hold the IV anesthetic within his arm. As the medication entered the rest of his body it stopped his heart and he died. Patients somehow think a complication will not happen to them. You are wrong. They happen and they are unpredictable. I have witnessed every complication of spine surgery that exists. Fifth, why is it so heard to understand that when you are under stress that your body secretes stress hormones such as adrenalin and cortisol? These chemical reactions lower your pain threshold. The logical solution is to calm down your nervous system, de-adrenalize your body and the pain threshold will return to its normal level. Adding on the additional stress of surgery is the wrong answer. We presented a paper in Argentina that documented 37 patients with severe structural spinal problems whose pain resolved without surgery. They used a self-directed approach such as outlined on this website and in my book. They were all slated for surgery. So I am watching these patients dramatically improve while I am also observing multiple patients every day in my clinic having surgery done or recommended on normally ageing spines. Why did he not engage in these simple concepts to create the neurological shift that consistently happens? All of us who utilize these strategies feel that over 80 % patients will respond. What is the risk of learning about pain, getting better sleep, doing a little writing and meditating? None. We have witnessed hundreds of patients significantly improve or become pain free. The major obstacle to healing is simply a patient’s willingness to engage. What about your life? I am seeing a high percent of patients that have experienced major losses about the time his or her symptoms began. The hits are huge such as loss of a job, retirement, death of a spouse or child, etc. What is your life like? Do you really think you can make a rational decision in the face of a high level of adversity? Almost all of my patients have quickly seen the link between pain and stress. You are also very vulnerable to suggestion when under severe stress. Buyer Beware Right now he world of medicine is playing a dangerous game with you. You are being offered procedures for problems that do not exist. It has been documented in over a 1000 medical articles that anxiety and depression are major factors in predicting a poor surgical outcome. Yet another recent paper showed that less than 10% of surgeons are assessing it before making a decision to perform surgery. Several metaphors come to mind while pondering this scenario. One is playing the game of charades. Or what about the Wizard of Oz? Another that comes to mind is the famous tale of “The Emperor Has No Clothes”. Doctors really are smarter than this and so are you. What is going on? Medicine has to clean up its own act and it is a discussion well beyond the scope of this article. In the meantime you need to wake up and take responsibility for your own life and health. You may be walking into a Venus Fly Trap. You are being offered an operation with its attendant risks for a problem that does not exist. Really? Are you kidding me?