Second Opinion
Before you agree to surgery, get a read from someone who would not be the one operating.
Most back and joint pain never needs surgery. Edward Baumgartner Jr., MD is double board-certified in Anesthesiology and Pain Medicine, and he does not perform joint replacements or open fusions. Whatever he tells you about yours, he has nothing riding on it.
Why This Answer Is Different
A second opinion is worth what the incentive behind it is worth.
A second opinion is not adversarial. It is diligent. And it is most useful coming from someone whose recommendation is not shaped by what they would be the one to perform.
Dr. Baumgartner operates: SI joint fusion, Minuteman interspinous fusion, kyphoplasty, spinal cord stimulator implants. What he is not is an orthopedic surgeon or a neurosurgeon, so open decompression, multi-level instrumented fusion and joint replacement are not procedures he does. When he tells you one of them will not help, he is not turning down work of his own.
What he can do is establish what is actually generating the pain. Anesthesiology gave him command of the anatomy and the image-guided technique; Pain Medicine gave him the diagnostic discipline that says which structure to treat.
Most patients who arrive having been told surgery is the only option have never had the source of their pain identified precisely. That is the first thing this visit is for.
What Happens
The visit, step by step.
No part of this is unusual. It is what a diagnosis is supposed to involve, given the time it takes.
- 1
Your records are read before you arrive
Prior imaging, procedures, and notes, including operative reports where there has already been surgery. The appointment starts from what is already known about you, not from a blank page.
- 2
An unhurried history and a focused exam
Where the pain sits, what provokes it, what relieves it, and what your prior treatments actually did. Then an exam aimed at the structures that pattern implicates.
- 3
Your imaging is read again
Imaging shows what a structure looks like, not whether it hurts. New imaging is ordered only when the pattern calls for something the existing films cannot answer.
- 4
A diagnostic block, where one applies
Where the pattern points at a specific structure, a block confirms it before anything is recommended. Two separate medial branch blocks before radiofrequency ablation, a genicular block before knee ablation.
- 5
A written impression you can act on
A clear recommendation in writing, including a referral if surgery turns out to be the right answer.
What Gets Examined
- Where the pain sits, what provokes it, and whether it radiates.
- Range of motion, provocative facet and sacroiliac maneuvers, and a neurologic screen.
- Joint line, ligament stability, patellofemoral tracking, and gait, where a joint is the question.
- Your existing imaging, read against the exam rather than in isolation.
- Operative reports and the mapping of pain to surgical anatomy, where you have already had surgery.
- Diagnostic blocks to confirm which structure is generating the pain before any treatment is recommended.
What is examined depends on the problem. The detail for a given diagnosis is on its own page in the pain center.
The Answer You Might Get
“No, you don’t need this” is an answer he is free to give.
Most back and joint pain has a source that can be found and treated directly. Where that is true, the work is to identify the structure, confirm it, and treat it. An operation never enters the conversation.
Sometimes it runs the other way. If the exam, the imaging and the blocks point at surgery, he will say so and refer you. He has no more stake in that answer than in the other one.
And where the source is found and it is treatable here, the options are the ones a pain practice can actually offer: radiofrequency ablation, Intracept, spinal cord stimulation, genicular blocks, image-guided joint injections, PRP.
See everything the practice offers, or read more about Dr. Baumgartner.
Worth A Second Opinion
When it is worth the appointment.
Pain medicine has changed. The plan you were given five years ago, or even two, may no longer be the best one for you.
- A surgeon has recommended an operation and you want another read before you agree.
- You have had the operation and the pain is still there.
- You've been on long-term opioids and want a real path off them.
- You're getting injections that haven't worked, or have stopped working.
- You have a diagnosis but doubt it's complete.
- You're considering an implanted device, such as a spinal cord stimulator.
Ready When You Are
Find out whether you actually need surgery.
Two Houston-area locations. Same-week consults available. Most insurance accepted.