There are a number of complex variations in the role of the spine surgeon as it pertains to the patient’s employer and other concerned associates. The base of it all is that the spine surgeon has to establish a proper doctor–patient relationship with every player that he or she treats. It does not matter if the patient is an 18-year-old athlete who will never make it or the top star in the sport. The surgeon must cut through the sports apparatus, the team, and the publicity and be the patient’s doctor. Do not be sidetracked by publicity, media, mothers, wives, or the desires of all the other people in your patient’s life. Do not try to do anyone a favor; focus on the patient. Base your treatments and prognosis on what is best for your patient. The patient who leads the league in hitting is also a 26-year-old kid who just got married and has a lot of years ahead of him. Talk to your patient and find out the thoughts, and fears concerning his or her career objectives. Analyze the patient’s case medically and understand your patient’s job.

What does the athlete has to do to succeed in his or her sport? You need to understand the sport and what exactly your patient’s job is. Understand the athlete’s position on the field and what he or she physically and mentally has to do to succeed. Understand what training the athlete needs to do, what he or she should. Take the history, examine the patient, review the studies, and add patient’s job requirements to your recommended treatment and prognosis. When in doubt, do a complete history and physical on the patient. The surgeon must have an overall objective of accomplishing what his or her patient wants. If it is return to maximum performance, then that should be the objective of the diagnostic and treatment plan. If the patient desires to retire, then adjust the treatment plan accordingly.

Additionally, the spine surgeon has to make decisions that are in the best long-term interest of the individual patient and must assume the responsibility of the patient’s safety while performing his or her job and developing a safe plan of return to high function. The decision to recommend surgery on an athlete’s spine must have his or her return to full performance as a major consideration if that is the player’s desired outcome. This means that the surgery should be as minimally invasive as necessary to correct the problem so as not to cause secondary symptoms because of the approach, but the surgery must also have the highest chance of success in correcting the problem. A spine surgeon who does only spinal surgeries and has a lot of experience with difficult spine surgeries in patients of all ages adds perspective to the specific problems in athletes. It is important that the surgeon can offer a nonoperative rehabilitation alternative when possible. If the surgeon does not understand and have experience with a good nonoperative rehabilitation
program, he or she cannot have a full understanding of the indications and need for surgery. The surgeon must understand the long-term consequences of the surgery; having a lot of experience with patients of all ages helps that understanding.