Why You Need a Second Opinion Before Spine Surgery
If a physician tells you that you need spinal surgery, it’s important to consider getting a second opinion from an experienced spine surgeon before you agree to a course of treatment. This is especially true if you feel unsure about your treatment options.
Penn Medicine-Virtua Health neurosurgeon Stephen Dante, MD, strongly encourages his patients to seek second opinions and he also welcomes second opinions. They’re essential he says, because patients should make informed decisions and feel confident in what they choose. Not only that, but they should feel confident in their physician’s experience and reputation, too.
Before seeking a second opinion, Dr. Dante recommends researching hospitals as well as surgeons who not only perform spinal surgery routinely, but with whom you feel comfortable.
“Part of what we need to do as providers is make sure that patients have a sense of confidence and good communication. Surgery is a big step, and patients should feel empowered to take charge of their recovery, to feel proactive,” Dr. Dante says.
Board certified in neurological surgery since 1995, Dr. Dante is a leading expert in the field of spinal surgery. He values comforting patients who come to him with undiagnosed spinal issues, as well as those seeking a second opinion from a trusted expert.
To ease his patients’ anxiety, Dr. Dante starts by explaining their underlying condition, trying to shed light on how their issue might have developed. “I try to put things into a perspective that allows them to understand what the basic problem is. It’s important not to confuse people with technical jargon,” he says.
Patients typically end up in Dr. Dante’s office with similar sets of symptoms:
- Chronic back or neck pain
- Weakness, numbness, or pain affecting an arm or leg
Dr. Dante asks to see copies of any diagnostic tests the patient has undergone. As a second resource, he can offer a new perspective, backed by nearly 30 years of studying, caring for, and operating on the spine. He may understand the problem differently or support what the initial doctor said. Either way, his goal is to provide each patient with the most appropriate recommendations for their spinal diagnosis.
“I always tell patients that unless there’s an urgency to proceed with surgery—which, fortunately, is not that common—to find an approach that makes the most sense to them and to find a surgeon who they feel truly has their best interest in mind,” Dr. Dante explains. “If they have a treatment option they can’t understand, is that really the right path to take?”
In some cases, second opinions can drastically alter the course of treatment. Anywhere from 10 to 62 percent of second opinions result in a major change in diagnosis, treatment, or prognosis, according to a 2014 study in the journal Mayo Clinic Proceedings. The findings further support Dr. Dante’s recommendation for a second opinion.
A patient might be told that surgery is not an option, leaving the patient to wonder if the pain will ever go away. But then a second opinion reveals that surgery is possible. Conversely, a patient may be told he needs spinal surgery, when really he can start with a more conservative approach.
Those differences in treatment approach have to do with a surgeon’s training or experience. Additionally, technological tools for imaging or surgery may not be available at certain institutions, leading physicians to make recommendations based on the tools they have available.
Dr. Dante says that with spinal disorders specifically, patients can experience a wide spectrum of problems—and as a result, a significant variation in treatment options and approaches. After nearly 30 years in practice, Dr. Dante says he prefers to be conservative with surgery, listening to each patient’s goals and concerns, and often trying non-surgical approaches first. The exception, he says, are the rare spinal tumors or other conditions that compress the spine and require treatment sooner rather than later.
“We don’t like to leave the spinal cord compressed if there’s a change in spinal cord function,” Dr. Dante explains. “The longer it’s compressed, the more chance function will be lost even after surgery.”
In order to provide the best possible second opinion, Dr. Dante says he needs to see a patient’s diagnostic images—as well as the patient. He also prefers not to make a diagnosis without first meeting the patient in person. This also benefits patients, who can gain a sense of comfort and confidence by meeting the surgeon who may perform their surgery.
“With spinal disease, you treat the patient, not the pictures. You have to look at the whole constellation of symptoms and images,” says Dr. Dante. “A second opinion is most valuable when I can talk to the patient, hear what the symptoms are, and do a neurological exam.”
Watch for red flags
Patients often consider a second opinion if they feel pushed toward surgery right away, without leaving time to digest the diagnosis or do further research.
Rightfully so, Dr. Dante says. That’s where you need to be on guard. “The red flag is sometimes an enthusiasm or aggressiveness to try to get the patient to commit to surgery then and there.” A surgeon who tells you that you need surgery should support you in seeking out a second opinion before you make your decision.
Instead of asking his patients to schedule anything further in the same moment as the consultation, Dr. Dante prefers to talk with them, show them images from their scans, and give them information to read further. He wants patients to have all of the information they need to make an informed decision about surgery, and he remains available to answer any questions as they process the information.
“Patients make a more informed, more comfortable decision if they feel they don’t have that time constraint or pressure,” Dr. Dante says.
He speaks from experience as a surgeon and also as a patient himself. When a patient is trying to make a connection with a surgeon, it’s crucial that the effort goes both ways, Dr. Dante adds. “It’s important that you (as the patient) feel that you’re not just another number, that you have time to explain your concerns and fears.”
If you’ve been told you need spinal surgery, it’s important to take the time to make sure that your physician has your best interest in mind and that is the best course of treatment for you. Sometimes, that requires a second opinion.
Updated August 12, 2020