Dennis Bruns

CHECKLIST FOR SURGERY Questions to Answer Before Undergoing a Spinal Surgery QUESTIONS COMPILED BY Dennis Bruns Musculoskeletal Physiotherapy Specialist EXPLANATIONS WRITTEN BY & Dr. John Nordt Expert Spinal Surgeon YouTube.com/@PhysioDennisBruns YouTube.com/@JohnNordtSpineCenterofMiami CHECKLIST FOR SURGERY 13 Question Checklist 1. Do I really need a recommended surgery? 2. What are the non-surgical alternatives to surgery and what are their risks and benefits? 3. Is the surgery based purely on MRI findings or other diagnostic images or has the whole clinical picture been examined? 4. Did the surgeon take the appropriate time to look at my case in detail? 5. How likely will my condition get worse if it’s not surgically addressed? 6. What are the qualifications, background, and motivation of the surgeon? 7. Is the surgeon in good standing/are there any reports of malpractice or license suspension ? 8. Is the surgeon welcoming to interdisciplinary work with others: physicians and therapists? 9. Is the surgeon known to follow up closely with patients after surgery? 10. Is the surgeon part of a Physician Owned Distributorship? 11. Does the surgeon hold large stocks in a medical device company? 12. Has there been effort to avoid costs related to medical imaging (or has it been quickly and easily ordered)? Have I been informed well about cheaper alternative diagnostic tests? 13. Has the surgeon attempted to provoke fear about consequences if I do not get surgery quickly? Did the surgeon try to quickly convince me into surgery? ©PHYSIO DENNIS BRUNS | PAGE 2 CHECKLIST FOR SURGERY Explanations for Each Question 1. Do I really need a recommended surgery? The surgery should not be based solely on an image or a picture, and if the doctor never takes your clothes off and never examines you, then you’ve lost that information. If you need a recommended surgery, it has to do with having significant clinical findings, significant weakness. 2. What are the non-surgical alternatives to surgery and what are their risks and benefits? Unless you are going on a fast downward trend towards paralysis, or loss of muscle, bowel, or bladder function, you have time to exercise non-surgical alternatives. A nonsurgical alternative is basically physical therapy, strengthening weak muscles, restoring flexibility, correcting posture, and also clarifying where the pain is actually coming from, which is not done consistently. You want to do everything possible to exhaust those alternatives before surgery is recommended. 3. Is the surgery based purely on MRI findings or other diagnostic images or has the whole clinical picture been examined? If an MRI alone is being used as the diagnostic image, then there’s a flaw there because it has to match the clinical findings. If one is never examined, one doesn’t know what the clinical findings are. 35% of normal people off the street will have an MRI that could justify surgery when there’s nothing actually wrong with the patient. A lot of inappropriate surgeries are done, over 800,000 a year, on people who did not need the surgery in the first place. There has to be other criteria that have failed before one even moves to surgery. ©PHYSIO DENNIS BRUNS | PAGE 3 CHECKLIST FOR SURGERY 4. Did the surgeon take the appropriate time to look at my case in detail? He or she should have looked at your history and asked you questions. Do you hurt when you stand, sit, or lie down? Do you have leg pain or back pain? The medical standard is that you are disrobed, your reflexes in your lower extremity and upper extremity are checked, the muscle weakness in each muscle group is checked, the ability to move your spine left and right, up and down, and forward is all examined. It’s very important to have a deeper discussion about what’s causing the pain exactly. You can’t just gloss over it, because I think all patients are bright, intelligent, and a little bit of education can alleviate your anxiety. 5. How likely will my condition get worse if it’s not surgically addressed? If you’re seeing a doctor and he says, “It’s going to get worse,” you have to ask him, “What’s going to get worse?” You want to make sure you are considering all alternative solutions, in particular all options of passive and active physical therapy before undergoing a surgery. 6. What are the qualifications, background, and motivation of the surgeon? Generally a spine surgeon is an orthopedic spine surgeon or a neurosurgeon. Neurosurgeons are nerve doctors. They’re electricians. Many do not understand bone fusion, stability, instrumentation, and fixing spines so they can fuse. An orthopedist is a functional construction guy, and can do something to fix it if it’s necessary. But just beware: The more you do in the back, the higher the charges go as far as money is concerned. If you have an employed surgeon, he or she is going to earn points (RVU’s), and the more points he or she makes, the more it justifies their salary and bonus. ©PHYSIO DENNIS BRUNS | PAGE 4 CHECKLIST FOR SURGERY 7. Is the surgeon in good standing/are there any reports of malpractice or license suspension? This is easily researchable. You can go online and locate this information. 8. Is the surgeon welcoming to interdisciplinary work with others: physicians and therapists? If a surgeon is welcoming to you having a second or third opinion that is a good indication that they are ethical. 9. Is the surgeon known to follow up closely with patients after surgery? It is important that there is a systematic close follow up post surgery, and if possible, this should be in a thorough interdisciplinary way including physical therapists and others who may be involved. It is wise to discuss what this process will look like with your surgeon. 10. Is the surgeon part of a Physician Owned Distributorship? A physician-owned distributorship means he owns part of the company that is selling the instrumentation, the screws, the rods and all that. If that’s the case, then he gains some financial compensation because of that. There are specific laws and rules federally and otherwise to prevent that, and several doctors have actually been sanctioned severely with jail time because of that inappropriate relationship. 11. Does the surgeon hold large stocks in a medical device company? The stocks in the medical device company should be a matter of record and they should disclose them to you. ©PHYSIO DENNIS BRUNS | PAGE 5 CHECKLIST FOR SURGERY 12. Has there been effort to avoid costs related to medical imaging (or has it been quickly and easily ordered)? Have I been informed well about cheaper alternative diagnostic tests? Generally speaking, ordering medical imaging quickly is a clear red flag, if they’ve not examined you thoroughly and just want to have a quick assessment of what’s going on. Imaging can be a part of the doctor’s compensation if he’s employed with a medical institution or with a hospital. 13. Has the surgeon attempted to provoke fear about consequences if I do not get surgery quickly? Did the surgeon try to quickly convince me into surgery? Generally unscrupulous surgeons could say something outlandish like, “If you don’t get this done, you’ll be paralyzed in the next day or two,” and that’s absolutely not true. This is an example of undue influence, when a surgeon just talks somebody into something when in fact there’s no legitimacy to go forward with that. Acknowledgements I extend my gratitude to Dr. John Nordt for sharing his knowledge on the subject matter, and to Rahula Shakya-Friedensohn for helping with the editing, proofreading, and formatting this document. ©PHYSIO DENNIS BRUNS | PAGE 6