Spine Surgery Mistakes & Misdiagnosis: What You Need to Know
Avoiding the Wrong Spine Surgery: Why Clear Communication Matters
Imagine going through spine surgery only to realize it didn’t fix your problem—because the wrong level was operated on, or because you didn’t need surgery in the first place. Unfortunately, misdiagnosis and wrong-level surgery happen more often than you think. But the good news is, you can take steps to minimize this risk. As a board-certified neurosurgeon, I’ll show you how—and why clear understanding and communication of your symptoms can make all the difference in getting the right diagnosis and the right surgery.
Why Imaging Alone Isn’t Enough
On occasion, when I first meet a patient and begin asking about their symptoms, they respond by telling me I can look at their MRI report and know what’s wrong. This is a common misconception that I often find myself clarifying. These radiology reports will have a lot of big words like facet joint hypertrophy, stenosis, anterolisthesis, retrolisthesis, degenerative disc disease, Modic endplate changes, loss of lordosis, and so on. This can all sound very concerning—if it doesn’t read as “normal,” then people understandably are inclined to think that there’s something wrong.
Understanding Normal Spine Aging
But here’s what many people don’t realize: as we age, we age on the inside just like we age on the outside. Just as our skin wrinkles and our hair turns gray, our spines age as well. This includes the discs drying out, losing some of their height, and bulging. The joints get bigger—just like you see in people’s knuckles when they have arthritis in their hands. The ligaments that hold our spine together can get thicker. And all of this can lead to some narrowing, or stenosis, around the spinal cord and nerve roots over time.
It’s natural for our spines to age. How we age is based on genetics, lifestyle, medical conditions, use of nicotine or drugs, and so on. So it’s not uncommon for MRIs and CT scans to show these common signs of aging. Your radiology report is likely going to have a lot of big words written all over it—and it doesn’t necessarily mean that these findings are causing your symptoms.
A large study looked at over 3,000 people who had absolutely no back pain or any symptoms at all. Researchers examined common age-related spine changes like disc degeneration, loss of disc height, bulging discs, joint wear and tear, and vertebrae slipping out of place. The results were surprising: by age 50, 80% had disc degeneration, 56% had some disc height loss, and 60% had bulging discs. As people get older, these numbers increase—with 93% of 70-year-olds showing disc degeneration and nearly 70% having joint wear and tear.
The key takeaway: these changes are a normal part of aging and don’t always cause pain or problems. As spine surgeons, our goal isn’t to treat every abnormality seen on a scan. Instead, we focus on addressing the structural issues that are directly responsible for your symptoms. Just as wrinkles or gray hair are natural signs of aging, many spine changes are harmless. The key is to identify and treat only the abnormalities that are truly affecting your function and quality of life.
If the true source of your symptoms is not accurately identified before surgery, operating on the wrong level of the spine or performing an incorrect procedure will obviously not provide relief. This is why your surgeon must listen carefully to your concerns, conduct a thorough physical examination, and meticulously review your diagnostic imaging. These steps ensure not only that the surgery is the right treatment, but also that the procedure is properly planned to address the specific symptoms.
The Importance of Describing Symptoms Clearly
When meeting with your surgeon, it’s crucial that you clearly articulate all of your symptoms. Are you experiencing pain in a specific arm or leg? If so, where exactly? Do you have weakness with certain movements? Is numbness affecting your entire hand or just specific fingers? Is it only at night when you sleep, or is it present all the time? Is your pain worse in the morning, or does it get worse when you walk? Does it improve with leaning forward or leaning back? Are you experiencing imbalance when walking? Are you having bladder issues? Does your discomfort involve all of your joints or just one limb? Have you been dealing with persistent low back or neck pain for 50 years, or is this a recent, progressively worsening issue? Did your symptoms develop suddenly or gradually over time?
Organizing and clearly communicating these details will help your surgeon accurately pinpoint the source of your symptoms—and determine whether they’re even related to your spine. I’ve created a basic guide to describing your symptoms in preparation for your spine surgery consultation. You can download it from the link in the description, fill it out, and take it with you to your consultation.
Real-World Examples of Misdiagnosis
I recently saw a patient who had undergone surgery in her lumbar spine—her low back—by another surgeon, but her symptoms of imbalance and bladder dysfunction persisted. After careful examination and comprehensive review of her symptoms and imaging findings, I discovered her main problem was actually in her cervical spine, which is in the neck. After performing surgery on her cervical spine, her symptoms dramatically improved.
I’ve also met more than one patient who had cervical spine surgery for symptoms that were actually due to an underlying neurological disease that required medication for treatment—not surgery. This highlights why precise diagnosis is absolutely crucial and why you need to be clear about your symptoms when describing them to your surgeon.
Precision Starts With You
Getting the right diagnosis is the first step toward a successful spine surgery—and you play a crucial role in that process. By clearly describing your symptoms and working closely with your surgeon, you can help ensure that the right treatment is performed for the right problem. Stay informed, ask questions, and take an active role in your care. Because when it comes to the spine, precision matters.