Not Sure Spine Surgery is Right for You? 13 Spine Surgery Facts You Need to Know From Dr. Kevin Pauza

I’m Dr. Kevin Pauza, a recognized spine specialist and surgeon. For the last 30 years, I have treated royal families, celebrities, and diplomats worldwide for back symptoms. In that time, I have seen just about everything related to back pain and the surgeries intended to resolve it.

My own experience trying to improve patient outcomes led me to research and develop the use of a biologic that resolves the root cause of patients’ muscle spasms and sciatica without performing invasive spine surgery. This research on minimally invasive back procedures has revealed some important facts that anyone considering traditional spine surgery needs to know.

The medical knowledge around muscle spasms and sciatica has evolved significantly during the course of my career. Hindsight is certainly 20/20, but looking back I believe that some unsuccessful procedures and surgeries could have been avoided if my colleagues and I knew what we know now. 

I learned early that spine fusions were not as effective as many patients and physicians believed. My primary responsibility as a University of Pennsylvania Resident was to treat the failed surgeries of Rothman-Simeone and Herkowitz, my mentors who wrote The Spine (considered the “Spine Bible” in the medical community). While the surgeries they performed were technically flawless, they often failed to achieve the intended patient outcome of eliminating pain from spasms or sciatica.

I recognized that the prevailing paradigm followed by the majority of spine surgeons was flawed.

Dr. Kevin Pauza’s 13 Spine Surgery Facts

Here are 13 facts to correct the teachings that physicians such as myself learned about muscle spasms and sciatica during our initial medical training. My hope is that they will help patients become better informed about their options around back surgery and choosing invasive vs. minimally invasive spine surgery.

(1) Massage and physical therapy cannot correct the root cause of muscle spasms and sciatica. This is because the real culprit is often an underlying disc leak, not a pinched nerve problem like we once thought.

(2) Surgery cannot repair leaky discs (previously called degenerated discs or bulged discs). Research has now proven this fact.

(3) There is always an underlying issue that leads a muscle to spasm—it doesn’t just happen out of the blue. Every muscle spasm originates from that muscle’s nerve. Often, the root cause of spasms is inflammation of the spinal nerve (from leaking discs or related conditions). Though massage feels great and may temporarily relieve the spasm, if the underlying inflamed nerve remains untreated, the muscle spasm will inevitably occur again.

(4) When nerves cause a muscle spasm, it is because the nerve is irritated or inflamed. This is often due to chemical inflammation of the nerves and not because nerves are actually pinched.

(5) Out with the old, in with the new: the accurate term for “pinched nerves” is inflamed or irritated nerves. Many seasoned spine surgeons still misuse the phrase “pinched nerve” when they are often referring to spinal nerves that are inflamed. Inflamed nerves cause symptoms like sciatica; very rarely is the spinal nerve actually pinched.

(6) Be your own advocate and remind spine surgeons that having a nerve that is pinched is not always the root cause of back pain and symptoms. 

(7) Spinal nerve inflammation is most often caused by “leaky discs.” This occurs when a spinal disc develops a tear and the gel inside of the disc (called the nucleus pulposus) leaks out (the medical term for this is “chemical radiculopathy”).

(8) Surgeons cannot sew leaking discs back together following a discectomy. Sewing a disc back together would be like trying to stitch together pieces of tissue paper, which is impossible. Common sense dictates that to repair a disc after being cut on, it should be sealed with fibrin through a minimally invasive spine surgery.

(9) Spine fusions cannot stop leaking discs, period. That’s why I repair failed spine fusions every week for patients from around the world using minimally invasive spine procedures.

(10) Back symptoms don’t originate from bone spurs or discs pinching nerves alone. Nerve inflammation from the leaking disc gel is always present first and is the direct cause of muscle spasms, sciatica, and other symptoms.

(11) Even bone spurs themselves are directly caused by leaking discs.

(12) Removing the offending disc or bone spur(s) pinching nerves does not permanently correct symptoms. Many people end up undergoing multiple back surgeries in an unsuccessful attempt at resolving recurring back pain.

(13) Symptoms are not always visible or diagnosable from a spine MRI or CT. Surgeons should not base their decision to operate on imaging alone (New England Journal of Medicine, July 1994). Physicians should consider using diagnostic annulograms, which are more current than outdated discograms that carry the risk of causing further damage to the discs.

Spine Fusion or Minimally Invasive Spine Surgery? Know Your Options

Consider these facts first before making a decision about traditional spine surgery. A less invasive spine procedure may be a more advisable and effective option. I’m always here to answer your questions.

Dr. Kevin Pauza, MD


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