Aaron Filler, MD, PhD

Trulli Trulli

Oxford University
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Sciatica, lower back pain, neck pain and pinched nerves – these are conditions that affects millions of people every year. If you have suffered from any of these, then you’ve also been faced with a vast array of choices. Should you see a chiropractor? Will yoga help? How about acupuncture? Does the pain mean that you’re going to need back surgery? Will you need pain medication? What about physical therapy?

There are many cause of spine pain. The problem could be a pulled ligament or a strained muscle that will recover on its own in few days. However, what if it is a slipped or herniated disc? Is your back pain going to go away on its own, or is it a new part of your life that will affect you for years?

“Do You Really Need Back Surgery: A surgeon’s guide to neck and back pain and how to choose your treatment” from Oxford University Press is a breakthrough book that places a wide array of information directly in your hands. Written by one of the world’s foremost authorities in spine health – Dr. Aaron Filler, MD, PhD – this book is like a series of extended doctor’s appointments with the most expert spine specialist in town. In the book, Dr. Filler discusses how yoga can help, what pain medications –  like Oxycontin and Vicodin – are most useful, differences among the special strengths of physical therapy,  traction, acupuncture and spinal injection (epidurals, nerve blocks, discograms and more).

Dr. Filler explains what aspects of sciatica or back pain can point to the need for surgery and also explains which back pains may be come from somewhere other than your spine – an ulcer, a kidney stone, even a tumor.

Sciatica may come from a pinched nerve in the pelvis (piriformis syndrome), or from a herniated disc. An MRI may show that a herniated disc is likely to resolve on its own or that surgery is likely to be needed. “Do You Really Need Back Surgery” helps you understand how an expert spine care specialist is likely to approach your problem.

If you need surgery, then what kind? A laminectomy or a fusion? How about the new artificial disks? How does a herniated disc relate to a pinched nerve? If pain medication is needed – what kind is best? Do you need to worry about addiction? By reviewing and comparing dozens of different kinds of pain medications, discussing the relative merits of physical therapy, yoga, ergonomics, and surgical operations, Dr. Filler helps you gain perspective. He provides an invaluable opportunity to educate yourself about your spine, your back pain, your sciatica. With 80 illustrations, an extensive glossary of hundreds of terms, and chapters on every topic from ergonomics, to post-operative recovery, this book will dramatically improve the effectiveness of your time spent with your own spine care professionals.

Excerpt from the Book:


How to Use The Book: Two Dozen Visits to Your Doctor

Do You Really Need Back Surgery is meant to give you the chance to learn just about everything you might want to know about every phase of trouble with your spine. There are very few people who will want to sit down and read it cover to cover.  Although, there are many people who may eventually want to read most of it.

The best way to use this book is as a series of visits to the doctor as your spine problem progresses. The first half of the book covers every aspect of knowledge relevant to keeping your spine healthy and understanding its pains and sprains. The second half of the book explains all aspects of medical and surgical spine treatment – from injections, to surgeries.

Do you need to know what is happening when you first experience a severe back spasm – will it go away, what does it mean, how can you make things better – this is all laid out in Chapter 1.

What about pain medicines? Which kind should you take? What is pain really anyhow? Should you mask it with pain killers, or are will you be hiding some urgent message from your body to rush to the hospital – answers to general pain questions are in Chapter 2.

How about some general information that helps you know about staying away from the doctor? The book covers work and home ergonomics and spine protective lifestyle options in Chapter 3, choices of exercise programs, and non medical therapies in Chapter 4.  

 To understand what is happening and to communicate effectively with various spine care professionals you need to know the language so Chapter 5 is devoted to a detailed overview of normal spine anatomy.  This is followed up by Chapter 6 which explains all the standard types of spine breakdown – herniated disks, bone spurs, and nerve pinches.

How does a doctor go about tracking down the source of a spine related pain? That is the subject of Chapter 7 – which disk will send pain to your big toe and which will make your biceps weak.  How about congenital problems and their implications – that’s laid out in Chapter 8.

All the tests, X-rays, MRIs, CTs – what are the differences, how do they work, are there risks, what can they reveal, how can you be sure you’re getting the best quality test – this is subject of Chapter 9

Some basic facts about injury and recovery of nerves and spinal cord are explained in Chapter 10.

The second half of the book answers your questions about treatments and surgeries. Sure, if it comes to surgery, you need to get your information direct from your own doctor – but can you remember to ask all the questions you meant to ask. Do you get overwhelmed  and find yourself looking for any excuse to end the appointment and run from the building? Is your doctor so excellent,  famous, and successful that he or she only has five minutes to answer your two hours worth of questions? Explaining the Spine can help.

An explanations of all sorts of injections and treatments carried out by needle through the skin is presented in Chapter 11. The basic elements of a patient’s experience during any trip to the operating room is provided in Chapter 12. All the basic types of routine spine surgery are explained and illustrated in Chapter 13.

More unusual and delicate surgeries on spinal cord and nerve are explained in Chapter 14. The complex subjects of spinal fusions and implanted spinal hardware (screws and plates) are introduced in Chapter 15.

Details of complex spinal surgeries in the neck are presented in Chapter 16, low back (lumbar) surgeries are laid out in Chapter 17, and surgeries for the problems in the thoracic spine are covered in Chapter 18.

What about new technology? Should you have your surgery now or should you suffer a little longer to hold out for the next big advance or miracle cure? There’s no way to predict the future, but the future does arrive in medicine down a very long pipeline. A breakthrough in 1990, may only reach final approval for patient use in 2005, so Chapter 19 can tell you a great deal about the pluses and minuses of what’s coming along just around the corner.

If your surgery is already scheduled or just completed you may want to know all about the various risks (Chapter 20), or about what to expect in your recover (Chapter 21). How about the costs and insurance coverages? This is a complex subject and Chapter 22 may help you understand at least how to ask the right questions.

I am an active practicing spine surgeon. I attend all the latest meetings. I’m an inventor who has created some of the important advances in the field. I work in a community of thirty or forty spine surgeons in West Los Angeles who compete to provide the best spine care in the world to a very well educated and demanding patient population – we all talk to each other and share discoveries, problems and challenges. I’m also a teacher who has trained surgeons at UCLA, taught college students at Harvard, and who spends dozens of hours each week educating and learning from my own patients. I do surgeries, I do injections and I do yoga.

What I’ve tried to do with this book is to empower patients to understand what is happening when there is trouble in their spines. I find that patients want their doctor to take care of them, but they are also looking for a partner with a sincere interest in their well being. I enjoy the partnership aspect, but this works best if the patient can understand as much as possible about what is taking place.

In summary then, this book should be used as a resource to help you get the most out of your visits with your own spine care professionals. In the end, you have to rely on the judgment  and advice of your doctor. This book doesn’t begin to provide enough information for you to know what they know in giving you their opinions and advice. However,  it should help you to ask the right questions and to better understand the answers. 

I thank you all in advance for taking the time to read Do You Really Need Back Surgery. I wish you all the best for a successful recovery from your spine problem.

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