Why second opinions are common in spine care
Spine problems often have more than one reasonable answer. Two people with the same MRI can have very different symptoms, and one condition can often be treated several ways. A herniated disc may be treated with therapy, an injection, an endoscopic operation or a microdiscectomy. A worn disc in the neck may be treated with a fusion or an artificial disc. A long curve may be treated with a short fusion, a long fusion, or no surgery at all.
Because the choices vary and the stakes can be high, many people want a second set of eyes. You are not being disloyal to your first doctor. A careful surgeon will not take it personally and will usually help you send your records.
What the research shows
A 2021 review pulled together 14 studies on second opinions in spine surgery. Across those studies, about 4 in 10 spine visits were second-opinion visits. In roughly 6 in 10 of those cases, the second surgeon's advice differed from the first in some way. When it differed, the second surgeon most often suggested trying nonsurgical care first.
These studies have real limits. They did not follow patients long enough to show which advice led to better results. A different opinion is not always a better one. What the research does show is that spine surgery decisions involve judgment, and that another careful review can change the plan.
When a second opinion makes the most sense
- You have been advised to have a fusion, especially at more than one level
- You have been told you need deformity correction surgery or another large operation
- The diagnosis is unclear, or your symptoms do not seem to match what the surgeon found on your images
- You were told only one option exists, and you want to know about others, such as a cervical disc replacement instead of a fusion
- You were told nothing more can be done, and you are still struggling
- You have had spine surgery before and your symptoms came back
- You simply do not feel comfortable with the plan or feel your questions were not answered
When not to wait
A second opinion should not delay urgent care. If you have loss of bladder or bowel control, numbness between the legs, or leg weakness that is getting worse by the day, go to an emergency room. If you have spinal cord compression in the neck and your hand function or balance is getting worse, see a spine surgeon promptly, since cord damage may not fully recover. In these cases, get care first and ask questions along the way.
How to prepare
A second opinion is only as good as the information behind it. Before the visit, gather:
- The actual images, not just the reports. Ask the imaging center or hospital for your MRI, CT and X-rays on a disc or through a secure online link. The surgeon will want to look at the pictures directly.
- The written reports for each scan.
- The first surgeon's notes, including the recommended operation. If you had earlier spine surgery, the operative report is very helpful.
- Records of treatment so far, such as therapy notes, injection dates and how much each helped.
- Your own summary: your main symptoms, what you most want to be able to do again, and your questions.
Getting records can take a week or more, so request them early. Our guide to common MRI terms can help you understand your reports before the visit.
If you live outside Fresno
Many people in the Central Valley have been told to go to Los Angeles or the Bay Area for a second opinion. That is sometimes the right call, but it can mean long drives and time off work. A spine surgeon closer to home can often review your case first and tell you whether a trip to a large academic center makes sense. If you are coming from a smaller town, ask whether your images can be sent before the visit, and plan the day so you are not rushed. Bringing a family member to take notes also helps when the drive home is long.
Insurance and cost questions
Many insurance plans cover a second surgical opinion when surgery has been recommended, and some plans require one before certain operations. Medicare Part B covers a second opinion before surgery that is not an emergency, and a third opinion if the first two disagree. Check with your plan about referrals and coverage before you schedule.
What a good second opinion looks like
A second opinion should be an independent review, not a rubber stamp or an automatic "no." Expect the surgeon to:
- Take your history and examine you in person
- Look at your images directly, along with the written reports
- Explain what they think is causing your symptoms, and why
- Lay out the options, including nonsurgical care and doing nothing for now
- Tell you clearly whether they agree with the first plan, and if not, what they would do differently
Sometimes the second surgeon agrees completely. That is still useful, because you can go ahead with more confidence.
If the two opinions differ
Ask each surgeon to explain the reasoning behind the advice. Useful questions include: What are you trying to fix? What happens if I wait three or six months? What would make you change your recommendation? If the problem is not urgent, it is often reasonable to try the less invasive path first, as long as you know what signs would mean it is time to reconsider. A third opinion is also an option when you are truly torn.
When to call us
If spine surgery has been recommended and you would like another review, call the office to set up a visit. Tell the staff you are coming for a second opinion so they can let you know what images and records to bring. Dr. Higginbotham will review your case and give you his honest view, whether that agrees with your first surgeon or not.
Common questions
Will my first surgeon be offended?
Most surgeons see second opinions as a normal part of care for major surgery. You do not need to explain or apologize. You can simply ask their office for copies of your records and images.
Do I have to tell the second surgeon what the first one said?
It helps to share the first surgeon's notes, so the second surgeon knows what was recommended and why. Some people prefer to let the second surgeon look at the images first and then compare. Either way is fine.
How long does a second opinion take?
The visit is usually similar to a regular consultation. The longest part is often collecting records and images ahead of time, so start that early.
Sources
- Gattas S, et al. Second opinion in spine surgery: a scoping review. Surg Neurol Int. 2021.
- Second surgical opinions, Medicare.gov
- Talking With Your Doctor, MedlinePlus (NIH)
- Know Your Back, North American Spine Society