Here are some critical questions a patient should be asking their spine surgeon before considering Spine Surgery. Do I really need a recommended surgery ? What are the non-surgical alternatives to surgery? And what are their risks and benefits ? What are the upsides and downsides of the non-surgical alternatives (for example: less risky and cost (significantly) less) ? How likely will my condition get worse if it’s not surgically addressed? Can it be done minimally invasive as possible? What are the qualifications, background and motivation of the surgeon? Is the surgeon really a medical docto ..read more

Back in 2009, (13 years ago) the American Academy Orthopedic Society (AAOS) published my article on a prediction that our country would have a significant manpower shortage in medicine.  You can download the article here.  The coming manpower shortage in medicine Well, here we are in 2022 and sadly this prediction has come true.  Here are some recent stats: The Orthopedic specialty is facing a shortage. According to financial planners Physicians Thrive, the number of orthopedic surgeons is expected to shrink by about 5,000 physicians. The supply of surgeons is&nb ..read more

Upon review of the eight episodes of Dr. Death, about the failings of a spine surgeon and the terrible consequences of his poor practice of spine surgery, I have several comments. It is sad that each hospital administration used him to make money, as the mention of 2-4 million dollars per year for a neurosurgeon working a hospital under the salary and the control of the administrators. It is unfortunate the employment of a physician such as that subrogates the physician to the will of the administrators as far as ancillary billing and surgeries that are questionable at best. This employment r ..read more

I’ve been performing kyphoplasty since 2000. I thought it was an amazing spine procedure. An amazing procedure happens about once every 10 years and before that it was pedicle screws. Kyphoplasty has been relegated to non-surgeons at this point in time, and the indications and the idea bio-mechanically has sort of been diluted out and not understood by many of those doctors. The kyphoplasty procedure places a balloon into a recently fractured vertebral body, and I talk about recently within the last four to six weeks. I know for a fact that these fractures heal after six or eight weeks, becomi ..read more

A differential diagnosis is a process, a mental process, that one is taught in medical school in order to facilitate understanding and trying to figure out what’s wrong. The body of information you use in medical school has a lot to do with how your differential diagnosis is applied. If someone has pain in the head, where is the pain coming from? Is it eye strain? Is it an ear infection? Is it a brain tumor? Is it a stroke? Is it a parasite in your head? Those are six or seven different just off the cuff things that can occur. It can have an inflammatory arterial disease. It can cause a proble ..read more

So, I think the interesting thing about today’s training of surgeons, both orthopedics and neurosurgery, as far as it relates to spine, has a lot to do how they’ve been trained. Years ago, when I started my residency in the mid seventies, which was a while ago, we didn’t have MRIs, we didn’t have cat scans. What we had was our eyes and our ears, and we listened and we examined. And based on those things, with a great deal of trepidation, we moved ahead to do a surgery or treat someone either operatively or non-operatively. This is how I was trained to see patients. And you listened to them. Th ..read more

As a spine surgeon, having been a Professor at the University of Miami for three or four years, I practiced in Miami-Dade County doing spine and ultimately only spine since 1999. To do spine surgery, one has to have clear evidence of what the diagnosis is. For 10 years, I practiced in Miami until MRIs came out in 1988 or 1989. MRIs clearly showed problems in pathology, in both the cervical and lumbar spine. There are many papers written in the early 90s in New England Journal of Medicine and Journal of Bone and Joint Surgery that discuss abnormal MRIs in otherwise pain-free normal people. 35 ..read more

The Space Program started in 1962 with the Mercury, Apollo, Gemini, and then the Shuttle.  It went through for about 50 years, and then nine years ago it stopped.  The Shuttle was expensive. It was subsidized by the Federal Government, and eventually, it was stopped because of monetary issues, budget issues, and a failure of push to financially go forward.  Following that, here we are 9 years later, Space X has taken over.  Elon Musk has shown what privatization will do.  He is motivated and focused on setting up a program that will be self-sufficient financially in th ..read more

Due to the Coronavirus epidemic and the downturn of reasonable reimbursement under the circumstances, it has become apparent that the business of medicine, as reflected by hospitals and insurance companies, has been pulling in the reins.  There have been recent articles about reducing salaries to physicians and nurses who are employed by the entity.  This is unheard of.  These people are saving lives and risking their own lives.  The first salaries that should even be affected are the board members and the administration of the hospitals and insurance companies.  This ..read more

About 23 years ago, the North American Spine Society, which is a multidisciplinary spine organization nationally and the American Academy of Orthopedic Surgeons came out with an algorithm for managing lower back pain. This came out on April 26, 1996. This algorithm demonstrated how to do an evaluation, and include an exclusionary diagnosis. One started off with a significant history and a full clothes off physical examination. Exclusionary diagnosis were inclusive of trauma, tumors, and previous surgeries, etc. A doctor would work through an algorithm with exercise and medication based on dia ..read more