Do I Need a Neurologist?

Most spine surgeons are asked to evaluate people and to make determinations for surgery. Once a person goes to a surgeon, they are going with the thought that they do need surgery. These people are generally upset when surgery is not scheduled immediately as they are symptomatic and “just need to get something done”.

Let’s talk…..

Most of the time, even though you were sent to a surgeon, you do not need surgery. This should be a great relief for most people.  Spine surgery is usually necessary when there is a significant risk for your life, or an important bodily function.   These situations are rare.  Most people who have back pain do not need surgery and get better in the next 3 months with conservative measures.

One reason that surgery may not be beneficial for a certain person is when the patterns of pain, numbness, or intermittent weakness may not be totally consistent with spine problems. When spine problems are ruled out you may be referred to a neurologist, who is a type of physician who is an expert in diagnosing conditions that may mimic a surgical problem.

To give an example, people with diabetes may have numbness, tingling, and pain to the arms and legs.  For diabetics, the reason may be their high blood sugar levels have now caused changes to the nerves throughout the body.  These nerve changes can cause similar (but not the same) symptoms as those who have significant pinched nerves to their spine.  A neurologist, with different tools like nerve conduction studies, further diagnostic testing of the brain, the spinal cord, and physical exam testing can determine if the complaints are related to something such as diabetes.

The neurologist will also use their expertise of physical examination to explore the possibilities of other entities that can cause some of the spine like conditions.  These can include Multiple Sclerosis, side effects of chemotherapy or even circulatory problems.  These conditions are not helped by spine surgery and are often made worse.

You will always be able to find a surgeon who will take the risk of doing surgery for you.  Without a life-threatening situation, it may be more prudent to pursue further evaluations before making a surgical decision. One of these decisions could be to see a neurologist if it is recommended.

Citations

  • S A, Gurtoo A, M S, Ap MK. Level of Health Literacy Among Type 2 Diabetic Persons and its Relation to Glycemic Control. J Assoc Physicians India. 2019 Apr;67(4):59-62. PubMed PMID: 31299841

Hi I am Dr. John Shim and today I want to talk about why you need to see a neurologist. As a spinal specialist, and with my surgical experience, I am often asked to evaluate people and to make determinations for surgery. Most of the time, the answer is you may not need surgery at this time. To me, that should be a great relief for most folks. As an orthopedic spine surgeon and specialist, surgery is usually necessary when there is a significant risk for your life, or an important bodily function. Thank goodness, those situations are rare. In fact, if you have time to watch this video, I hope it is because while you have pain, you are not experiencing such a life or bodily functioning threatening issue. If you are... STOP watching this video and go to an emergency room, and contact your physician right away. Let's get back to the discussion about why you may need to see a neurologist. Spine surgery can be helpful for others with more chronic conditions, as long as all the options have been explored, and other potential causes of your complaints are investigated. Spine specialists often will come to a conclusion that surgery may not be beneficial for a certain person. The patterns of pain, numbness, or intermittent weakness may not be totally consistent with a spine source. A spine specialist may refer you to a neurologist, who is a type of physician expert in diagnosing conditions that may mimic a surgical problem. To give an example, people with diabetes may have numbness, tingling, and pain to the arms and legs. For diabetics, the reason may be their high blood sugar levels have now caused changes to the nerves throughout the body. These nerve changes can cause similar symptoms, but not exactly the same symptoms as those who have significant pinched nerves to their spine. A neurologist, with different tools like nerve conduction studies, further diagnostic testing of the brain, the spinal cord, and physical exam testing can determine if the complaints are related to something else, such as diabetes. The neurologist will also use their expertise of physical examination to explore the possibilities of other entities causing your spine conditions. While going to a neurologist may seem intimidating, in reality, finding your diagnosis is very important, while also exploring the possibility of surgical management. Frankly speaking, unfortunately I have seen patients who had complaints that did not completely match a spine source of pain or nerve findings who did not follow my advice to obtain further evaluation or examination by a nonsurgical specialist like a neurologist. Unfortunately, due to desperation of pain, they pursued other surgical options instead and had surgery. I can tell you that surgical treatments for conditions that will not improve with surgical management is a really bad outcome. When a surgeon recommends further workup by a nonsurgical specialist, I strongly recommend patients to follow through with that evaluation. I know many of your frustrated with the pain, and the chronicity of the condition. I understand, you will always be able to find a surgeon who will take the risk of doing surgery for you. Without a limp or life-threatening condition, it may be more prudent to pursue further evaluations before making a surgical decision. I'm Dr. John Shim. As I always say, I am not try to tell you what to do. At the same time, as an orthopedic spinal specialist, and my experience of thousands of operations, I urge you to listen to your surgeon if there is a recommendation for further nonsurgical workup. Thank you for taking the time to watch the video. I hope you will find a solution for your current complaints.

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