Why Imaging Doesn’t Tell the Whole Story

Every day I review MRIs, CT scans, and X-rays. These images help me understand the structure of the spine and identify where there might be degeneration, nerve compression, or instability. They are critical to planning surgery, but they are not the whole story.

Some patients come in with severe-looking scans but only mild symptoms. Others have relatively normal imaging yet describe deep, persistent pain that keeps them from living fully. That disconnect is a reminder that surgical decisions should never be based on imaging alone.

The spine is more than a stack of bones and disks. It is tied to how we live, how we move, and how we feel. That is why I always start by asking one simple question: what matters most to you?

Redefining What “Success” Looks Like

Traditionally, surgical success was measured in technical terms. Was the implant placed correctly? Is the alignment improved? Did the nerve decompression work? These are important, of course. But I have learned that patients care about something else entirely, how surgery changes their life.

They want to walk without pain. Pick up their kids. Go back to work. Sleep through the night. Play a round of golf or go hiking again. These are the real-world goals that define success for them.

When I meet with a patient, I take time to understand their daily routine, their responsibilities, their hobbies, and what they feel they have lost because of their spine condition. That context helps me guide them toward the right treatment, not just the “right-looking” scan result.

The Power of Motion Preservation

One of the best tools we now have in spine surgery is artificial disk replacement (ADR). For many patients, ADR allows us to relieve pressure on nerves and reduce pain while preserving motion in the spine.

Motion matters. It allows people to move naturally, reduces stress on nearby joints, and often leads to quicker recovery. For someone who wants to stay active, play sports, or keep working a physical job, preserving flexibility can make all the difference.

I remember a patient in her 40s who came to me with significant neck pain and numbness in her arm. She was told she needed a two-level fusion, but her biggest fear was losing the ability to move her neck comfortably. After evaluating her case, I offered a two-level cervical ADR instead.

A few weeks after surgery, she told me she could turn her head while driving again and felt like she had her life back. That is what success looks like.

Hybrid Approaches for Real-Life Problems

In some cases, we combine motion-preserving and fusion techniques, taking a hybrid approach. These are especially helpful in multi-level disease where not every level is a good candidate for ADR.

The goal is to balance strength and flexibility, giving patients the best chance at pain relief without sacrificing too much motion.

This approach is not about performing the flashiest procedure. It is about customizing the plan to fit the person in front of me. That may mean preserving one level and fusing another or using a minimally invasive approach to reduce downtime.

What matters most is choosing a path that aligns with the patient’s personal goals, not just what the textbook says.

Emotional Recovery Matters Too

Spine conditions take a toll not just physically but emotionally. Chronic pain can lead to depression, isolation, and frustration. People lose confidence in their bodies. They stop doing the things that bring them joy.

That is why emotional recovery is just as important as physical recovery. When we relieve pain and restore function, we help patients feel like themselves again.

One of the most powerful moments in my practice came from a patient who told me, “I feel like I have hope again.” She was not just talking about pain relief. She was talking about being able to plan her future. Go on vacation. Return to the gym. Pick up her grandchild.

Surgical success is about giving people their future back.

Listening First, Operating Second

The most valuable tool I have is not a scalpel or a robot. It is listening. By listening closely to what patients are experiencing, what they value, and what they fear, I can design a surgical plan that truly fits their life.

This might mean recommending a less invasive option or avoiding surgery altogether if it is not needed. Sometimes the right call is to do nothing at all. Surgery should never be automatic. It should be intentional, personalized, and meaningful.

A Better Future for Spine Surgery

Spine surgery is evolving. We have better implants, better imaging, and better tools than ever before. But the most important evolution is in how we define success.

It is not about achieving the perfect alignment or placing the implant exactly where the textbook says it should go. It is about helping patients regain function, freedom, and control over their lives.

When we put the patient first and the procedure second, we build a partnership that leads to real, lasting results. Not just in the spine, but in the whole person.

That is the future of spine care. And it is one I am proud to be part of.