Dr. Tim Tollestrup explains why back surgery is such a gamble and cannot help patients who have a peripheral nerve problem involving superior cluneal nerves. He also discusses the four different type of patients who present with back pain and why only one of the four can be helped with spine surgery. Dr. Tollestrup has performed hundreds of successful surgeries on patients with superior cluneal nerve pain.
Tim Tollestrup MD/Pain-Focused Peripheral Nerve Surgeon
“The reason that you have failed back surgery syndrome, and that back surgery in general, enjoys such a poor reputation is that there are so many people who have these peripheral nerve problems that appears just a surface view that back surgery is a crapshoot or a gamble.
I’m convinced that this is a condition that exists because of the lack of understanding of the peripheral nervous system by people at all steps of the process. Treating somebody who presents with low back pain or sciatica pain, spine surgeons are completely ignorant about peripheral nerve anatomy and that sounds kind of harsh, but that’s just the way it is.
I’ve spoken with spine surgeons, and if you utter the word superior cluneal nerves they look at you like a deer with headlights. They’ve never heard of these nerves, even though you can flip open any anatomy book and there they are.
With spine surgeons, the measure of success is what does the x-ray looks like or the CT scan after the fact. Yes, it is a technically perfect operation. The fusion is fused, or the joint place has been replaced and we’re all good.
The problem is that peripheral nerves can closely mimic the same kind of pain that a true problem with the spine might produce. You have a back problem and it’s like you can either treat it conservatively if you can stand it or have spine surgery and those are really the only options out there. These patients will go and have their laminectomy or discectomy or fusion and then you know they’re not better or they’re worse. Inevitably the spine surgeon will tell them your back surgery is perfect and then they’re given a referral to pain management and offer a spinal cord stimulator. None of these treatments will work if the problem is a peripheral nerve problem.
Somebody who has a true spine problem if they have surgery, they’re going to do great.
If someone has a peripheral nerve problem and that patient gets operated on at best, they’re going to partial improvement, so some pain went away, but some remained and hopefully what remains wasn’t made worse by the surgery.
The third type of patient is somebody who starts out with a spine problem only but because of the back surgery has a complication with peripheral nerves, and these superior cluneal nerves that I mentioned are very susceptible to being traumatized or injured is result of any kind of spine procedure. So, in that case you’ll have a patient who may be the original problem is back, but now they have an entirely new problem or a pain that is slightly different and a different location although superior colonial nerves are close to the spine so it can be hard for the patient to determine that. So again, that patient will not be happy after spine surgery.
If somebody has a peripheral nerve problem and gets misdiagnosed as having a spine problem or the source of pain is coming from the spine. These patients will have spine surgery and will not be better and potentially worse. They are also unhappy.
These are the four categories of patients who present with sciatica pain and only one of them is going to do well with spine surgery. That is why spine surgery has such a poor reputation.”
Dr. Tim Tollestrup MD Website https://nevadanervesurgery.org/
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