Some patients have been coming to me for years, and some I have operated on more than once. From the outside that can sound odd. A surgeon you have to keep going back to? Nobody goes back to their surgeon for ten years after an appendectomy.
And the answer to how long the relationship lasts depends on what the problem is. For most patients it is one episode, and that is that. There are, however, a few situations where the relationship lasts for years, and that has a clinical reason behind it, not a habit.
Surgery for a spinal tumour is followed by regular check-ups, typically for years. This does not depend on whether the patient feels well; it follows from the nature of the disease. The purpose of the check-up is that if something changes, it comes to light in time.
Here the long relationship is not a choice. It is part of the treatment.
In certain complex spinal conditions, surgery solves one problem but does not remove the disease itself. It happens that an additional procedure is needed years later.
The patient needs to know this in advance. If someone goes into surgery believing that everything is now settled, and then years later sits in front of a surgeon again, that is a disappointment. If they know that this may be part of how the condition runs its course, then the next consultation is not a failure but a continuation.
The spine is not a single structure but a long system made up of many segments. Someone who came at forty with their lower back may find that at fifty their neck speaks up too.
I have several patients whose neck and lower back I have both operated on, years apart. This is not a consequence of the earlier surgery. They are two separate problems in the same person. The advantage is that in such a case we do not have to start from scratch. I know the history, I have seen the earlier scans, I know what worked.
This is the most common long relationship, and it is the one that contains the least surgery.
In many patients the spinal complaint returns periodically. The treatment is then periodic too: a targeted injection, physiotherapy, help through a worse spell. It can go on for years without surgery, because none is needed.
There are patients who have been coming to me for ten years, and in that time have had one operation and many more consultations that ended with the conclusion that nothing needs doing right now.
In this situation the value of the relationship is not the intervention but the judgement. That someone who knows the history decides again, on each occasion, that surgery is still not needed.
This is the most important point, because this is the majority.
In younger patients I often see that a disc herniation or an acute spinal complaint resolves, whether with non-surgical treatment or with surgery, and afterwards they do not need to come back. The spine has a better capacity to recover at this age. Histological studies show that the blood supply and the biological reserve of the disc decline gradually with age, and that this process already begins in the second decade of life.1 The problem closes, and so does the relationship.
With most of my patients I meet only during the illness itself. They recover, and I do not see them again. That is the goal, not the exception.
In all four situations the same thing repeats, and it is not the operation. It is the decision that repeats, and only the question is different each time.
This is why whoever decides should know the whole story. If I know that the same leg hurt two years ago and what made it settle, it becomes clear sooner whether the current complaint is the same one. If I do not know that, the workup starts from the beginning, and the decision rests on less information.
The long relationship is not needed because of the number of operations, but so that every decision is made in the knowledge of what came before.
If you are coming with a spinal complaint for the first time, you are probably coming for one episode. Most patients are. How an assessment and a possible operation unfold step by step is set out on the patient journey page.
If the workup shows that the situation is more complex, I will tell you in advance what to expect. Not to frighten you, but so that you know how your condition naturally runs its course, and are not taken by surprise.
The relationship between a spine surgeon and a patient is long because the spine changes over the long term. And it is short because most problems resolve.
This information does not replace a medical examination.
If surgery has been recommended elsewhere and you want to know what follows from it in the coming years, that is what a second opinion is for.
This article draws on observations from my own practice rather than on external evidence. The only external reference concerns the age-related change of the intervertebral disc: