The Doctor Says You Need Spine or Brain Surgery: Do You Need a Second Opinion?


Dr. GradyFinding out you need spine or brain surgery can be scary. It’s normal to have a whole host of questions: Will I be okay? How long is the recovery process? Does surgery work?

Before you put together those pieces of information, there’s one step not to overlook—getting a second opinion about whether you need surgery at all and who is the best surgeon for you.

M. Sean Grady, MD, Surgeon and Chairman of the Department of Neurosurgery at Penn Medicine, explains why this is so important.

Q&A about second opinions

What would you say are the top reasons a patient should get a second opinion about spine or brain surgery?

Well, the first reason is to make sure that the second opinion is in agreement with what your first doctor had to say. You want them to be on the same page with diagnosis and treatment. It gives you more confidence in your decisions when a second doctor has looked everything over and said, “Yes, I’d do the same.

The second is about choice of surgeon. That choice is extremely important—you need to choose the person you’re most confident would take care of you if you have complications from your surgery.

The third reason goes along with that: You need to make sure that the entire team will be there to take care of you.

For example, if you have a malignant brain tumor—a cancerous tumor that’s spreading—you don’t just need the surgeon. You need a neuro-oncologist, a radiation oncologist, and other specialists. And it’s much better if everyone’s in the same medical system. It makes handoffs smoother, makes it less likely for information to get lost. It’s just much more efficient.

Since part of getting a second opinion is choosing a surgeon—what qualities would you recommend patients look for in a surgeon?

Remember—part of getting a second opinion is giving yourself more options for choosing a surgeon you’re comfortable with.

Dr. Grady Second Opinion

If someone does find out he has a serious condition like a brain tumor, does he really have time to get a second opinion?

It’s actually pretty rare for spine or brain surgery to be a true emergency that has to get done within a few hours. Most of the time, you can wait on surgery, and go get another opinion.

Let’s say you have a seizure, are taken to the hospital, and are told you have a benign, or non-cancerous, brain tumor. That’s not necessarily an emergency. While you might be worried about having another seizure, you usually can take medication for the seizures and then go get another opinion.

Benign tumors are very unlikely to change over 1-2 months. Even malignant tumors change very little in 1-2 weeks, so you have plenty of time to get that second opinion.

What stands in the way of patients getting second opinions?

I’d say that a lot of times, they’re scared. They’ve been brought to the hospital, or told they have something like a tumor—and unless they have a family or friend who is a physician and advises them otherwise, they’re worried and just want to fix the problem as soon as they can.

It’s also sometimes a matter of convenience. Patients don’t always want to go through the process again, especially if they know the hospital well, or have heard that the surgeon is reputable. They have inertia—they’re going down a pathway, and they don’t want to start over.

Do surgeons get offended when someone gets a second opinion?

Absolutely not. In fact, if I’m the first person to see the patient, I encourage him or her to get another opinion. I’ll even recommend other surgeons I know who will give good opinions.

I don’t have an ego about my profession, and I think all doctors should be comfortable with the idea of second opinions. In many cases, medicine has a lot of grey areas, and second opinions can help you work through that to determine what’s best for the patient.

If a patient comes to you for a second opinion, should he tell you about the first opinion?

He can definitely tell me I’m the second opinion, but I usually don’t ask what the first doctor had to say before I make my diagnosis. I go through my diagnosis and treatment recommendation process first, and then I might ask what the first doctor had to say.

What happens when the opinions are different?

Even when our opinions differ, they’re often similar. But if you get two opinions that are vastly different—like two completely different diagnoses and two different surgeries—get a third opinion.

Once you’ve had an operation, there’s no going back. Be confident that you’ve explored your options, and you understand the diagnosis and possible complications. It’s important that you’re comfortable going ahead, no matter what.

Any memorable “second opinion” stories that stand out in your mind?

Just last week. I was the first opinion, but the patient had already reviewed the radiologist’s report indicating that she had a pituitary tumor. But when I looked at it, it was a normal scan—it had just been misinterpreted.

In her case, it absolutely benefited her to have someone else look at her scan. And I showed the films to our neuroradiologists to make sure I had interpreted the images correctly.

In general, I get a number of patients who have been diagnosed with a condition called cervical spondylosis based on their imaging, but no clinical signs or symptoms. They’ve been told they need spine surgery, or else they could become paralyzed if they were to fall. This is not true at all—I don’t know why physicians say this when there is nothing in the medical literature that supports it.

I tell these patients to keep monitoring it—come in every six months, and let me know if symptoms should appear. Spine surgery is over-utilized, and there are a significant number of operations that aren’t necessary. The second opinion, that they really might not need surgery, could spare patients from getting an invasive operation.

Whether you need a first, second, third, or seventh opinion, the neurologists and neurosurgeons at Penn are ready to help you make a decision about brain or spine surgery.

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