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BREAKTHROUGH: This Explains Why You Can’t Lose Weight in Your 40s · Doctor Drop It with Dr Barbara Hessel

• 0:00
  SPEAKER_00: Before you agree to spine surgery, there are four questions I want you to write down and bring into that room.
• 0:05
  SPEAKER_00: Because there's one thing about spine surgery that most patients only find out after they've already had it.
• 0:11
  SPEAKER_00: And once you know it, you walk into that appointment asking completely different questions.
• 0:16
  SPEAKER_00: I've spent 20 years treating back pain, doing both the minimally invasive procedures and the root cause work in one practice.
• 0:22
  SPEAKER_00: And I'll be honest with you, the cases I find the hardest aren't the complicated ones.
• 0:27
  SPEAKER_00: They're the patients who come to me after surgery, still in pain.
• 0:31
  SPEAKER_00: A lot of the time the surgery was done well.
• 0:34
  SPEAKER_00: They just said yes without the answers they should have had first.
• 0:37
  SPEAKER_00: So today I want to hand you those answers and what a good answer to each one actually sounds like.
• 0:43
  SPEAKER_00: Let's start with why surgery deserves more caution than anything else you've tried.
• 0:47
  SPEAKER_00: Almost everything you've done for your back so far can be undone.
• 0:51
  SPEAKER_00: An injection wears off, you stop physical therapy.
• 0:54
  SPEAKER_00: Nothing about your body is permanently changed.
• 0:57
  SPEAKER_00: Spine surgery is different.
• 0:59
  SPEAKER_00: When you have a spinal fusion, the surgeon places rods and screws across the bones and fuses the bones together, and that segment stops moving.
• 1:08
  SPEAKER_00: That's permanent.
• 1:09
  SPEAKER_00: And about half of spinal fusions don't fully take.
• 1:12
  SPEAKER_00: The bones don't knit the way the surgeons planned.
• 1:15
  SPEAKER_00: But what matters most is what surgery does to everything around it.
• 1:19
  SPEAKER_00: Afterward, you have scar tissue around the nerves, and the whole structure sits differently than before.
• 1:24
  SPEAKER_00: So the fusion holds one level still, and the level above and right below are now taking on extra load.
• 1:31
  SPEAKER_00: Over time, those neighbors weigh out faster.
• 1:34
  SPEAKER_00: They start to herniate, and now they need surgery too.
• 1:37
  SPEAKER_00: It becomes a domino cascade.
• 1:39
  SPEAKER_00: One surgery leads to more surgery, more scar tissue begets more scar tissue around the nerves, and another operation a couple years later.
• 1:46
  SPEAKER_00: And after all that, the honest number is about 50-50 on who actually gets better.
• 1:51
  SPEAKER_00: That's the thing patients learn too late.
• 1:53
  SPEAKER_00: If you jump straight to surgery, the anatomy gets altered, that the only thing left to offer you is more spine surgery.
• 2:00
  SPEAKER_00: Now here's the reassuring half.
• 2:02
  SPEAKER_00: The whole reason these questions matter.
• 2:04
  SPEAKER_00: There's a tier of procedures that sit between failed injections and the operating room, and almost none of it's permanent.
• 2:11
  SPEAKER_00: These reach the problem through a needle instead of a scalpel, and they leave your anatomy intact.
• 2:16
  SPEAKER_00: If the trouble is coming from the disc, we can place a biologic right into the disc to help it heal and seal from the inside.
• 2:23
  SPEAKER_00: That treats the actual source instead of just calming the pain down.
• 2:26
  SPEAKER_00: If it's lumbar spinal stenosis, which just means the canal your nerves travel through have narrowed and the nerves are getting pinched, there is a procedure called mild.
• 2:36
  SPEAKER_00: A small device removes the thickened ligament crowding the canal through a tiny incision.
• 2:41
  SPEAKER_00: No fusion, no hardware, under 30 minutes, and you go home the same day.
• 2:45
  SPEAKER_00: And a lot of what gets labeled lumbar back pain is actually the SI joint, where your pelvis meets the base of your spine.
• 2:51
  SPEAKER_00: It gets missed all the time and is treatable on its own.
• 2:55
  SPEAKER_00: Here's what ties all of those together.
• 2:57
  SPEAKER_00: Every one of them is reversible.
• 2:59
  SPEAKER_00: And if one doesn't hold, the next option is still there, and is so is surgery.
• 3:03
  SPEAKER_00: And I tell my patients, we still have an out.
• 3:06
  SPEAKER_00: Trying these first doesn't take surgery off the table.
• 3:09
  SPEAKER_00: It just makes sure you actually needed it.
• 3:12
  SPEAKER_00: Now let me be fair about surgery, because spine surgery is a necessity in certain situations, and I've never talked anyone out of surgery if they truly need it.
• 3:21
  SPEAKER_00: If you're losing strength or movement in your legs fast, that needs a surgeon's eye right away.
• 3:26
  SPEAKER_00: And if you're losing control of your bowel or bladder, that can be a nerve emergency at the base of your spine.
• 3:31
  SPEAKER_00: Don't wait, don't finish this video, go to the emergency room.
• 3:34
  SPEAKER_00: Those cases are real and surgery is the right answer for them.
• 3:37
  SPEAKER_00: But that's a small slice of the people in a spine surgeon's waiting room.
• 3:41
  SPEAKER_00: If you're dealing with ordinary chronic back pain, a cranky disc, and a referral, you're almost certainly not in that group.
• 3:47
  SPEAKER_00: Which is exactly why these four questions belonged in your pocket.
• 3:51
  SPEAKER_00: Question one, have I actually been evaluated for less invasive options?
• 3:55
  SPEAKER_00: So the first thing to ask is simple.
• 3:57
  SPEAKER_00: Have I actually been evaluated for the minimally invasive procedures, the disc treatments, the mild procedure, the SI joint treatments?
• 4:03
  SPEAKER_00: If the answer is no, ask for a referral to an interventional spine specialist before you agree to anything surgical.
• 4:09
  SPEAKER_00: Here's why that matters.
• 4:10
  SPEAKER_00: A surgeon telling you that the injections didn't work is not the same as being evaluated for these procedures.
• 4:16
  SPEAKER_00: Those are different treatments done by different specialists with different equipment.
• 4:20
  SPEAKER_00: Think about how you got here.
• 4:21
  SPEAKER_00: Your primary care sent you to physical therapy.
• 4:24
  SPEAKER_00: It didn't work, so then you went straight to a spine surgeon.
• 4:27
  SPEAKER_00: But a good spine surgeon finds that only 8 to 10% of the patients who walk through that door actually need an operation.
• 4:34
  SPEAKER_00: The other 90-some percent go back to physical therapy, back to prime repair, and get lost.
• 4:39
  SPEAKER_00: The whole detour can take three months or more.
• 4:42
  SPEAKER_00: Just to get in, order the MRI, come back to here, it doesn't look bad enough, they can't help you.
• 4:47
  SPEAKER_00: And a surgeon saying they can't help you is the right answer from a surgeon.
• 4:52
  SPEAKER_00: It isn't an evaluation for anything else.
• 4:54
  SPEAKER_00: If you were sent straight to a surgeon and nobody ever mentioned any of this, tell me in the comments how long ago your standards options ran out.
• 5:01
  SPEAKER_00: That timeline matters more than most people realize.
• 5:04
  SPEAKER_00: Question number two.
• 5:05
  SPEAKER_00: What exactly does this surgery involve and what does a recovery really look like?
• 5:10
  SPEAKER_00: The next question gets you the real picture instead of the brochure.
• 5:14
  SPEAKER_00: What exactly does this surgery involve and what does recovery look like?
• 5:17
  SPEAKER_00: Six weeks, six months, a year?
• 5:19
  SPEAKER_00: Ask specifically how many levels are being fused, because one level is very different recovery and a very different risk down the road than two or three.
• 5:28
  SPEAKER_00: Ask what the typical outcome looks like for someone with a back like yours.
• 5:31
  SPEAKER_00: Not the best case and not the horror story.
• 5:34
  SPEAKER_00: A surgeon who has done this many times can give you those numbers right off the bat.
• 5:38
  SPEAKER_00: If you only get the best case version, that tells you something too.
• 5:42
  SPEAKER_00: Question number three.
• 5:43
  SPEAKER_00: What happens if I have this surgery and still have pain?
• 5:47
  SPEAKER_00: Then the question most people are afraid to ask, what happens if I have this surgery and I still have pain?
• 5:53
  SPEAKER_00: Listen closely to the answer.
• 5:55
  SPEAKER_00: If it involves the possibility of another operation, you're hearing the whole domino cascade out loud, before the first surgery instead of after it.
• 6:03
  SPEAKER_00: The more specific the answer, the more the surgeon has thought about your case.
• 6:07
  SPEAKER_00: The vaguer it gets, the more they're describing the procedure, but not you.
• 6:11
  SPEAKER_00: Question number four.
• 6:12
  SPEAKER_00: If I try the less invasive options first, do I lose the chance to have surgery later?
• 6:16
  SPEAKER_00: And here's the last question, the one almost everyone has exactly backwards.
• 6:20
  SPEAKER_00: If I try the less invasive options first and they don't give me enough relief, do I lose the chance to have the surgery later?
• 6:27
  SPEAKER_00: Because most people assume the answer is yes.
• 6:30
  SPEAKER_00: They think trying more things means the surgical window closes on them, and so they rush towards the operation to protect it.
• 6:37
  SPEAKER_00: And that fear pushes people into surgery faster than their back actually requires.
• 6:42
  SPEAKER_00: For most structural back problems, the honest answer is no.
• 6:46
  SPEAKER_00: Surgery is still fully on the table after you try the reversible options.
• 6:50
  SPEAKER_00: Confirm it with your own surgeon for your own anatomy, and but a fear of losing the option shouldn't be setting your timeline.
• 6:57
  SPEAKER_00: Try the things you can undo first because we still have an out.
• 7:01
  SPEAKER_00: Do it in the other order and there's no out left.
• 7:04
  SPEAKER_00: So back to the thing patients only learn after the surgery.
• 7:08
  SPEAKER_00: Now you know it before.
• 7:10
  SPEAKER_00: Walk in already knowing what the less invasive procedures are, what a fusion does to the levels around it, and that you don't lose your shot at surgery by being careful.
• 7:20
  SPEAKER_00: That's a completely different conversation.
• 7:22
  SPEAKER_00: Stop walking in asking when should I have the surgery.
• 7:26
  SPEAKER_00: Start asking, have I actually tried everything that comes before it?
• 7:30
  SPEAKER_00: Because that second question is the one that protects you.
• 7:33
  SPEAKER_00: If you want to go one step further back, I made a whole video on the specific mistakes in pain management that keep people suffering for years longer than they should, the ones that land you at a surgeon's door in the first place.
• 7:45
  SPEAKER_00: This one gave you the questions for the room.
• 7:47
  SPEAKER_00: That one shows you how to keep from ever needing them.
• 7:49
  SPEAKER_00: Go watch it next.
• 7:50
  SPEAKER_00: There's a new video every week on everything that lives between injections and surgery.
• 7:55
  SPEAKER_00: The whole middle tier nobody talks about.
• 7:57
  SPEAKER_00: Subscribe so the next one finds you.
• 7:59
  SPEAKER_00: Your back pain didn't make surgery inevitable, and agreeing to it was never your only move.
• 8:05
  SPEAKER_00: You still have options right now, and that's something you can protect.
• 8:09
  SPEAKER_00: I'll see you in the next video.