I have been told that I have bulging discs, do I need surgery to correct this?

A bulging disc is not a diagnosis or medical condition that necessarily requires treatment of any kind.  As discs age, they frequently lose water content in the central part of the disc.  This results in loss of internal support for the ligament that surrounds the disc (the annulus) resulting in a bulging appearance of the disc on an MRI.  Studies of assymptomatic people above the age of 30 demonstrate the frequent presence of “bulging” and even herniated discs.  The likelihood of this finding increases with age despite the absence of symptoms in most people.  Treatment of this MRI finding in the absence of specific evidence that the degenerative disc is the source of symptoms is unnecessary and frequently harmful.  Bulging discs can not simply be removed, and no current treatment reverses the degenerative process.


What is the difference between an orthopedic spine surgeon and a neurosurgeon?

Neurosurgical training generally involves the diagnosis and treatment of of surgical disorders of the brain, spinal cord, and peripheral nerves.  Historically neurosurgical training did not include training in spinal stabilization surgery or treatment of spinal deformity.  Although more recently trained neurosurgeons receive more training in these aspects of spine surgery, many are now seeking additional training in spine fellowship programs similar to those developed by orthopedic spine surgeons and frequently receive advanced training from orthopedic spine surgeons in these areas.  Most neurosurgeons do not have fellowship training in advanced spine surgery.  Neurosurgical training does not incorporate education in musculoskeletal conditions that do not directly involve the brain, spinal cord or peripheral nerves.  Most neurosurgeons do not direct non-surgical care and treatment of spinal conditions.

Orthopedic spine surgeons complete a full orthopedic training program prior to sub- specializing in spine surgery.  This includes extensive training in the diagnosis and treatment of all musculoskeletal conditions including disorders of the spine,shoulders, hands, hips ,knees, and feet in adults and children.  An orthopedic spine fellowship involves training specific to the spine and usually incorporates a diverse training in surgical and non-surgical management of adult spinal disorders including spinal stenosis, disc disorders, trauma, and deformity.  Fellowship trained orthopedic spine surgeons usually specialize in surgical treatment of spinal disorders but also routinely manage the non-surgical care of patients as well.  This provides  patients with a spectrum of treatment options directed by a single specialist allowing the greatest flexibility in tailoring specific treatments to individual needs and circumstances.  The addition of extensive training in the evaluation and treatment of musculoskeletal disorders allows the orthopedic spine surgeon to easily distinguish spinal conditions from other conditions such as hip and shoulder pathology which are frequently confused with disorders of the back and neck, and occasionally result in misdirected spinal surgery.  Most of the modern techniques of spine surgery including spine fusion implants and disc replacement procedures  were developed by orthopedic spine surgeons.


Why can’t we just get an MRI to find out what is wrong with my back/neck?

The causes of back and neck pain are numerous and include many conditions that can not be evaluated adequately or appropriately with an MRI of the spine.  Proper evaluation of back,neck, and “pinched nerve” symptoms require a patients history and physical exam to be considered by an appropriately trained specialist in order to determine the proper course of diagnosis and treatment.  Most causes of back and neck pain can and should be treated  without advanced imaging.  Obtaining premature imaging frequently leads to incorrect diagnosis and treatment including unnecessary or inappropriate surgery.  Simple x-rays of the spine should always be performed prior to obtaining an MRI of the spine and should be interpreted by the specialist who is treating the patient.  MRI imaging is usually considered when invasive treatments such as injections or surgery are being
contemplated. MRI images should be directly reviewed by the specialist who is considering or performing the anticipated procedure.  Radiology reports alone are virtually useless for diagnosis or planning of surgical procedures and frequently result in misdirected care when not properly correlated with an individuals history and physical exam.  A particularly unacceptable practice is the ” review of MRI to determine necessity of surgery” prior to proper physician evaluation.  This unscrupulous and unethical practice is unfortunately becoming a common marketing tool for spine/neurosurgeons seeking to drum up business with the promise of not wasting a patients time with proper evaluation.  As one might expect the result is frequently misdiagnosis and improper treatment with the result of wasted time, economic loss, and suboptimal patient outcomes.  An ethical spine surgeon will never tell you whether surgery is necessary based only upon review of an MRI.