Surgery- When and Why?
The general goal of surgery is to relieve discomfort. This sounds straightforward, but it becomes a very complex and difficult decision to make in many cases. When a patient has severe debilitating pain where he or she cannot stand, walk, sit or even lie down, the options for surgery are clear.

In another situation, a patient has very mild pain and is tolerating it well. He is able to do everything he needs to do during the day. This is also an easy decision to make because no surgery would be indicated.

There is, however, a vast middle ground of patients where the decision is not as easily made. Age, location of the problem, associated medical conditions, and the degree of pain must all be reviewed before the decision for surgery can be reached.

The surgeon must constantly ask himself: "What can be accomplished with reasonable safety?" If the patient is young and has an isolated problem in an area that is reasonably accessible with a surgical approach, the decision toward surgery is much easier. If, on the other hand, the patient is older and has a difficult diagnostic problem or multiple medical problems, the decision is more complex.

Dr. Stark would never suggest a surgical procedure for pain that would likely get
better on its own within any acceptable timeframe. Nor would he suggest surgery if he thought the procedure would compound the problem you already have.

Often Dr. Stark will choose to do less surgery on the basis of safety alone. If two separate nerves are involved causing impairment, but one problem seems to be long-standing and the other very acute, Dr. Stark may choose to operate only on the more acute of the two. The reason behind this is that the long-standing problems have been tolerable to this point and the risks may be unacceptable.

In the end, it is the patient who must make the decision. Dr. Stark will make recommendations based on his knowledge and experience. The patient should understand and discuss those recommendations with their family and decide whether the benefits outweigh the risks. Every patient would like to avoid surgery. Their thinking is no different than those of orthopedists who have suffered from back problems and wish to avoid surgery. The spectrum of possible decisions extend from immediate surgery to long delays of any surgical treatment or complete deferment entirely. The decision is made on an individual basis. If the pain is severe or unbearable or the lesion is obvious and addressable, surgery would be recommended.

The purpose of the surgery is to relieve pain and improve function during this intermediate period between the onset of symptoms and the point at which maximum improvement will be reached five or ten years later. The orthopedist must factor in the patient's personality, the ability to tolerate such discomfort, their reliability and reasonableness, as well as their ability to safely sustain an operation before making such a decision.

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