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The Truth About Back Surgery

Surgery: Just Say "Not So Fast" continued...

The takeaway: If a doctor recommends an operation, get a second opinion — always. A good surgeon will understand that you need to be comfortable with any decision, and should provide your tests and records, says Alex Ghanayem, M.D., professor of orthopaedic surgery at Loyola University Medical Center in Maywood, IL. For a truly useful second look, and to find out if you would benefit from surgery, go outside your doctor's practice or center and consult with different types of specialists. Specifically:

Find a Very Busy Doc
A quality, fellowship-trained spine surgeon (that means someone who has done a year of spine training after residency) is likely to have plenty of patients, says Andrew R. Block, Ph.D., director of pain programs at the Texas Back Institute in Plano. "He doesn't need to talk you into an operation that isn't in your best interest."

Start from Zero
Don't tell the second-opinion doctor what's been recommended, advises Stephen Hochschuler, M.D., cofounder of the Texas Back Institute. Let him take a fresh look at you and your tests. Then, if the advice is different, you can mention what the first doctor advised and get his views on that.

Cross Disciplines
Get a second opinion from a nonsurgical specialist. If you tell a surgeon that exercise and other nonsurgical options haven't helped, that could tilt the decision toward an operation. But often patients haven't given other strategies a thorough trial — something a nonsurgical specialist would pick up on during an exam, says Alicia Carter, M.D., a physical medicine and rehabilitation specialist at New York-Presbyterian Hospital in New York City.

Log Out
Stay away from Web-based services where you send your scans for a second opinion. "Don't get medical advice without a face-to-face interaction," says Dr. Ghanayem.

Get a Third Opinion
If the second doctor offers a wildly different recommendation, another physician can help you sort it out. Doctors at university-affiliated medical centers, who generally see many complicated cases, might be best in this role.

So What Does Help?

Most back pain eases with time — no matter what you do. There's a tendency to think that whatever you were trying when the pain did let up was the treatment that worked, not realizing that your back simply healed over time. That's why you can't assume that what worked for your book group pal or for Sally in Accounting will help you, too (plus, they may not have had the same problem). And scientific evidence isn't much more reliable than Sally. Some studies have been too small to conclude much of anything, while others were so badly designed, it would be risky to follow their conclusions. Yet, there are clues — evidence reviews that point to treatments that help many people:

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