The Difficult Messages a Neurosurgeon Convey

By definition, neurosurgeons have a lot of uncomfortable discussions with their patients. At Bridger Cox, MD we go over the scans together and tell them, as gently as possible, that they have a tumor, a stroke, or any of a number of other brain and spine disorders. We discuss treatment options, surgery risks, and recovery timeframes, always with the correct balance of compassion and openness.

As difficult as those discussions can be, we believe one is arguably more challenging — and it’s perhaps not what you think. The most difficult talk neurosurgeons can have with the patients is telling them that they will not operate and that surgery is not the answer.

Neurosurgeons, particularly spine surgeons, have a lot of options for relieving pain and improving quality of life. They can repair herniated discs, remove malignancies, and even reconstruct deformed or traumatized spines.

Sometimes they have to advise a patient that surgery won’t help for a variety of reasons, including:

It’s far too early. They never do surgery before we’ve exhausted all other options. They will always try physical therapy, medication, or other methods first if we believe they can solve a patient’s problem. Patients don’t always want to hear that, which they understand because when you’re in pain, you want to get rid of it as soon as possible. However, we will never subject somebody to surgery if they can live without it. A nonsurgical therapy can eliminate the need for surgery, it’s a good investment.

It’s really too dangerous. Most routine procedures have minor risks, but they do exist. In virtually all cases, the advantage of a surgical repair surpasses the small risk of the treatment itself. However, there are situations when the surgical risk outweighs the possible benefit. For an elderly patient or with an underlying health condition that makes anesthesia extremely dangerous, or when treating the present problem risks triggering a wider problem, this can happen. They need to know that patients are aware of the risks of surgery, no matter how minor they are; nevertheless, if the danger is too great, they need to explain why they are unable to operate.

It wouldn’t make a difference. They haven’t uncovered the source of someone’s discomfort just because we found an aberration on a scan. Many people have damaged vertebrae (spinal bones), but they do not experience any discomfort. Some people have a little stenosis or a minor malformation, but nothing that causes symptoms. Ethical surgeons don’t operate to rectify an x-ray; instead, they operate to alleviate symptoms. It doesn’t assist anyone to undertake surgery and have a patient who is still in agony while having a flawless spine on a scan. A good neurosurgeon will not do surgery if it will not benefit the patient.

I don’t find anything. On the other hand, not seeing anything on a scan is a problem. “Exploratory” surgery is mostly a thing of the past because to tremendous developments in imaging over the last few decades. It’s rare these days for a spine to have a correctable defect that isn’t visible on a scan or in a functional study. They won’t propose surgery if the condition cannot be fixed.

Ask us at Bridger Cox, MD in OKC for any neuro conditions. Our doctor is competent and help you for pain relieving.

**Disclaimer: This content is not a medical consultation and also it does not suggest any doctor-patient relationship.

Originally published at on December 21, 2021.




We know people still need urgent neurosurgical care. It has never been easier to speak with a Board Certified Neurosurgeon, setup your virtual visit.

Love podcasts or audiobooks? Learn on the go with our new app.

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
J. Bridger Cox, MD

J. Bridger Cox, MD

We know people still need urgent neurosurgical care. It has never been easier to speak with a Board Certified Neurosurgeon, setup your virtual visit.

More from Medium

Sacrée fleur, day 1 in Paris

The Focus of The Daily Writing

Reading — “Atomic Habits”

Filling Up Missing Pieces of the Pokedex…3 Pokemon at a Time