Make the Most of a Second Opinion for Your Spine

If you’re considering surgery, you might want a second opinion. Here’s how to make the most of that visit.

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If you have back pain, the array of treatment choices can be dizzying. From medication to physical therapy to surgery, it’s easy to feel overwhelmed when deciding on the best solution, particularly when it comes to going under the knife.

That’s where second opinions come in.

Second opinionConsider a second opinion before you have spine surgery

But even seeking a second opinion can be overwhelming: Who should be the second expert you consult? What information do you need to share? What questions should you ask to make an informed decision?

According to Jamie Baisden, MD, a neurosurgery specialist and professor at the Medical College of Wisconsin in Milwaukee, there are two chief reasons to seek a second opinion. First, she says, “There is power in numbers. Having a second physician make the same recommendation as the first can drive home the fact that you’re on the right path.”

A second reason for an additional opinion, says Dr. Baisden, is to fill in any information gaps the first physician may have left open. “This can leave you hanging, uncertain about how to proceed,” Dr. Baisden explains. “A second opinion can provide you with more details and options, allowing you to choose whichever makes you feel most comfortable.”

To make the most of your time with a second clinician, it’s important to go to the appointment armed with the right questions and approach.

Whom to Ask

Before you schedule that appointment for a second opinion, carefully evaluate who you turn to for advice. This could range from a physical therapist to your primary care physician, or if surgery is on the table, a surgeon.

With the latter: “Look at the skill set of the second clinician you consult,” says Jason M. Highsmith, MD, a neurosurgeon at Charleston Brain and Spine in Charleston, SC. “There are great surgeons who don’t perform some mainstream surgeries, for instance. Their toolbox may be limited.”

If surgery is in play, this means ensuring the physician you consult performs the type of procedure recommended to you at a good rate of frequency. “If your first doctor recommends spinal fusion, for instance, look for a second one who does this and who is fellowship trained and has a good reputation,” says Dr. Baisden.

Also look for conflicts of interest, says Dr. Baisden. “Make sure the surgeon doesn’t have deals with instrumentation companies, because that can cloud judgment,” she explains.

If you’re struggling with finding the right doctor for the second consult, Dr. Highsmith suggests asking a variety of people you trust, from your primary doctor to friends/family in healthcare, or trusted peers.

Elizabeth Ewens, a 51-year-old attorney from Davis, CA, recently underwent surgery for spondylolisthesis after a lengthy process of trying various treatments and consulting with a number of practitioners. “I tried everything, from PT to medication and in the end, consulted with a surgeon,” she says. “Before I finally decided, I had an orthopedic doctor friend look at my films and listen to my history. He agreed this was the right option.”

Know that whoever you choose, getting in the door for that second opinion may take a while and may also hit your wallet hard. A 2020 study in the journal Surgical Neurology International found that the time to receive a second opinion in the United States ran anywhere from a day to five months, and the cost ranged from $90 to $1,300.

What to Ask

When you sit down with your second clinician, ask the right questions. “Start with telling him or her what your first physician recommends and asking if they agree with that,” says Dr. Highsmith. “If they don’t, ask what they do recommend.”

In addition, Dr. Baisden suggests that you inquire about the post-operative course if you are considering surgery. “Ask how extensive this will be, how long it will be, and what it will look like,” she says. “Make sure the doctor recommends rehab after your procedure, because no surgery is going to strengthen muscles.”

What to Bring

No matter which number of opinions you seek, no doctor can make the best recommendation without all the information they need. “The most important thing to bring are your images--all of them,” says Dr. Highsmith. “It’s rare, but some providers don’t share films outside of their offices because they don’t want their patients leaving their practice. This is a lack of transparency and not in the patient’s best interest.”

Should this happen, says Dr. Highsmith, know that you have a right to the films—you paid for them. It may take persistence and breaking through red tape, however.

In addition, “don’t assume the new doctor has all of your records,” says Dr. Baisden. “Bring your films, your records, studies and a history of injections. The more information you can provide, the better.”

This should include every course of action you have tried. If you went to physical therapy, for instance, bring information on exactly what you did there and for how long. “Divide up the information into the most relevant to the least relevant, and have a clear sense of what you’ve tried and what has failed,” adds Dr. Baisden.

Keep in mind that when doctors look at films, they’re likely to disagree on what treatment they recommend, adds Dr. Highsmith. “Show an MRI to 10 different surgeons and you’ll get six or seven different responses,” he says.

Dr. Highsmith also says you should bring a dose of caution into the appointment. “People often have unwavering trust in their physician, and that can be a mistake,” he says. “If after the second opinion you’re still unsure, it’s ok to get a third opinion.”

Now on the mend and getting ready for rehab, Ewens is pleased she went through with her fusion surgery. “In hindsight, I wish I had been a bit more aggressive with asking for films and seeing specialists, because I think I prolonged treatment,” she says. “But I’m very happy with my progress now.”

Updated on: 01/20/21
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