Surgery is a significant event in the lives of most patients. It involves cutting open their bodies, and for most of them, it is scary.

It is also a blunt instrument and quite crude; it creates an injury and always carries a risk. No matter how careful the surgical team is. No matter how diligent the post-operative care.

For me, there must be a real pathology to fix, AND it must help the patient on the path to a more active, pain-free life. Otherwise, it is surgery for the sake of itself.

To operate or not to operate?

In considering that question, I focus on three factors:

1. Patient symptoms

These are the hardest to decipher. Self-assessment of pain is personal and variable. Depending on the patient, the same pathology can be described as discomfort through to extreme pain. It can be specific and localised through to vague and generalised.

Pain also has several dimensions:

i. At an emotional level, it can vary from the passive – “please just fix my pain” – to the psycho-social types prone to catastrophising: “I am in agony, I can’t move”.

ii. There can be environmental factors: social conflict at home or work exacerbates people’s felt experiences. If there is a financial incentive – “I want compensation” – then people can exaggerate.

iii. Finally, there is the pathological condition – genuine physical symptoms.

2. Surgeon’s diagnosis

I take a detailed medical history and then use two clinical cross-checks:

i. Do the symptoms align with the accepted distribution of the nervous system? 

ii. Do they tally with the visual evidence presented by scans?

Even if the symptoms and diagnosis marry up, I will explore all the available treatments. Many conditions improve with time or with lifestyle adjustments. And if other therapies will not work, I still consider one final factor.

3. Positive physical outcomes

Will surgery deliver a positive outcome for your patient? Will it help them live a happier, more active life?

There must be alignment with all three factors before I recommend surgery.

I shy away from cutting people. There is no visceral pleasure to open someone up. My joy is in helping someone achieve an improved experience of life.

As always if you have any questions about a patient, please feel free to call me on 02 9650 4893. I will return your call and discuss how we can help.

You can also reach me via ralphstanford@powspine.com.au.


Further Resources available include:


Dr Ralph Stanford is a spinal surgeon with over 20 years’ experience. He is adept in all surgical approaches to successfully treat his patients.

Dedicated to lifelong learning and sharing his expertise with others, Ralph attends spinal conferences worldwide and regularly consults with colleagues about successful treatments.

As a teacher Dr Ralph Stanford is Conjoint Senior Lecturer at the University of New South Wales; Supervisor of Training for Orthopaedic Trainees, Prince of Wales Hospital; and Education Secretary for the Spine Society of Australia.

As a researcher and scientist, he is a well-published author and Honorary Senior Scientist at Neuroscience Research Australia (NeuRA). He is also a current member of Spinal PFET.


Posted 20 July 2020