Five reasons your Spine Surgeons may recommend different operations:

There are usually several possible treatment approaches to any spinal disorder, and depending on the severity of the case, the age and health of the patient, and the experience of the surgeon, there’s usually more than one way to approach a given surgical problem.

​If you’re getting a second opinion about spine surgery, it’s usually for one of two reasons – either you didn’t like what you heard the first time, or you want to make sure the recommendations you got are as right as they can possibly be.
So, when you get a completely different recommendation from your second opinion doctor you have to wonder: how can two experts see the same x-rays, hear the same story, examine the same body, and come to such different conclusions!?
McLain illustration of spinal surgery for thoracic disc herniation
​It can be as simple as this: One surgeon may be more familiar with your specific condition and have more experience treating it. They may have trained in a program that treated this problem extensively and may have developed techniques or become experienced with implants that most other surgeons haven’t gotten familiar with.  That’s great for you!  On the other hand, one surgeon may have fallen into the trap of “we’ve always done it this way” and may really be behind the times!  That’s not so good.
Here are six reasons your new surgeon may be recommending a different approach to your situation, and the questions you should ask before choosing a course of care.
1. They may not be familiar with one approach – not every surgeon is trained in the same techniques and surgical approaches, and some older surgeons simply don’t have the time or energy to go back and re-train in newer procedures they may not use frequently. Ask if your doctor has personal experience with both procedures? If they do, why are they recommending one over the other?

2. They may not feel comfortable doing one approach in every case – some surgeons, particularly when a procedure is new to them, will only apply those techniques in the most straight-forward cases.  That’s smart, and good medical practice.  If your case is more complicated, “pushing the envelope” may be risky and something they don’t want to do.

3. They may be very familiar with the approach but not think it’s right for you – on the other hand, a surgeon with more extensive experience with a procedure may be more aware of pit-falls and flaws in the strategy that make a given procedure a poor choice for you.  If that’s the case, they should be able to explain plainly why another approach fits your situation better.

4. They may have had a recent bad experience with the approach – Any surgeon who’s had a poor outcome with an innovative procedure will sit down and reassess that approach from one end to the other.  If the problems were unavoidable and unrelated to the new implant or new approach, fine. If they have any suspicion that the technique wasn’t as good as they thought it was, they may be very hesitant to try it again in another patient.

5. They may have become familiar with the approach, studied the literature, followed their patients, and developed doubts about the long-term results for their patients – if this is the case they may be ahead of the curve in tempering their enthusiasm for a procedure many others are very excited about. They should be able to explain their thoughts clearly and give you some examples of why they are skeptical.

6. They may have perfected a different approach that they are comfortable and confident in, and not want to change their practice – sometimes surgeons have become so quick and proficient with one approach that it just doesn’t make sense for them to fiddle with success.  If they can offer a reliable and successful outcome with their technique, better than what “new technology” is offering, then their tried and true approach may still be the winner in the long run.
Picture of spinal decompression
Whatever the reason for the difference of opinion, your surgeon should be able to give you their thoughts, and take the time to answer your questions, without resorting to tired “that’s the way I’ve always done it” or “ I just don’t believe in it” sorts of excuses.  So, ask good questions, and get good answers, before you make an important decision!