You just might find, you get what you need
Scholars are still undecided whether the song "You Can't Always Get What You Want" by the Rolling Stones from 1969 is a cynical commentary on the 1960s, when everyone believed in a utopian society, or whether it's a philosophical approach to life: You can't always get everything exactly the way you want, but sometimes, if you really try, you can get the things you need.
The desire for control, measurability, and perfection is more present than ever at the beginning of the 21st century. Especially in the medical world, it seems that scientific breakthroughs have fulfilled every dream. If you can't stop eating, your stomach can be reduced so that you still lose weight. If you can't have children, you can still fulfill your wish with the egg of another woman, the sperm of another man, and a surrogate mother. If you're not satisfied with your face, you can just buy a new one. There are deaf people who regain their hearing, blind people who can see again, and severely disabled people who can walk again. A complete health utopia lives among the wealthiest. Facebook CEO Mark Zuckerberg and his wife Priscilla Chan have set themselves the goal of curing, preventing, and controlling all existing diseases in the world. With a few billion in investments, the help of artificial intelligence, and blood monitors, that should be achievable. All fundraisers for terrible diseases promise their donors the same thing: if you just give money, we will make sure cancer, ALS, etc., will be eradicated. The sky seems to be the limit in healthcare.
As a surgeon, I understand very well how people with back pain think: "My GP sends me to the neurologist, who refers me to the neurosurgeon, and then my pain will be surgically guaranteed away." From the bottom of my heart: I wish it were that simple. But unfortunately, the human body is still not completely malleable. Life still holds secrets and problems for which there are no solutions. I often have to disappoint patients. Worldwide scientific research shows that one in seven people has chronic back pain and will continue to suffer from it. This has an evolutionary cause. When humans started walking upright, almost all body weight shifted to the lower vertebrae. The result is that these intervertebral discs and spinal joints are heavily loaded, especially in cases of insufficient movement or premature wear and tear.
In my previous blog post (“Why Me?”), I explain that the primary cause of back problems is genetically determined and therefore lies in human DNA. In addition, there are circumstances in daily life that seem to have an impact. Interestingly, the wear and tear I just mentioned occurs more slowly in people who heavily strain their backs. For example, I rarely see a mover or construction worker in my consultation room. The vast majority of my patients have sedentary jobs. Apparently, prolonged sitting accelerates spinal wear and tear.
The key question, of course, is why some people with chronic back pain undergo surgery while others do not. And you naturally want to know how a surgeon can predict who will have a successful operation. Fortunately, much is known about this. A significant predictive factor is, for example, the number of abnormalities the spine exhibits. If I see a healthy spine with a clear hernia in one spot, the chances are highest that leg and back pain will decrease after surgery. The worst-case scenario is when I see a spine with multiple worn-out intervertebral discs, a narrowed canal, and joints affected by wear and tear at multiple levels. In that case, surgery can even worsen the pain. Additionally, after surgery, muscle strength loss can occur because the spine is unable to recover. Between these two scenarios, there are more than 50 shades of gray. There's a scale of issues, and every time I see a patient, I must try to predict the likelihood of achieving the desired solution. That's the most difficult and challenging part of my job: No two spines are the same, no two nerves are the same, and no two people are the same. Every spine requires its own approach and has its own chance of success.
In my consultation room, the expectations of a possible operation are, of course, always sky-high. Pain is exhausting and depressing, and everyone wants to be rid of it for good. My job is to explain the patient's complaint in relation to the anatomical issues seen in the images as clearly as possible, especially when I decide not to operate in the patient's best interest. The first consultation is therefore the most crucial moment of the entire treatment. No, unfortunately, the patient can't always get what they want. But I will always try to help them with what they need. For this, I have fantastic colleagues who know everything about pain management. Sometimes it helps patients to acquire more knowledge about their own spine. When you know what causes your complaints and what to expect, you can learn to accept the pain. Everyone does this with their own coping mechanism, as psychologists call it. I often see that these coping styles make living with pain more bearable than endlessly fighting it, even though I understand how difficult such a process of acceptance is. No, you still can't get everything you want in back care. But sometimes, good communication between doctor and patient can lead to what you need: a better life with the same existing situation.
